EC 2021 Medical Electronics PDF

A Course Material on
Medical Electronics
By
Ms.P.VEENA
ASSISTANT PROFESSOR
DEPARTMENT OF ELECTRONICS AND COMMUNICATION

ENGINEERING
SASURIE COLLEGE OF ENGINEERING
VIJAYAMANGALAM – 638 056

QUALITY CERTIFICATE
This is to certify that the e-course material
Subject Code : EC2021
Scubject : Medical Electronics
Class : III Year ECE
being prepared by me and it meets the knowledge requirement of the university

curriculum.
Signature of the Author
P.Veena
Assistant Professor
This is to certify that the course material being prepared Ms.P.Veena is of adequate
quality. She has referred more than five books among them minimum one is from
abroad author.
Signature of HD
N.RAMKUMAR
ASSISTANT PROFESSOR
TABLE OF CONTENTS
S.NO TOPIC
PAGE NO
UNIT I
ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING
1.1 1
ORIGIN OF BIOPOTENTIALS
1.2 4
BIO POTENTIAL ELCTRODES
1.3 10
BIOLOGICAL AMPLIFIERS
1.4
ELECTROCARDIOGRAPHY(ECG)
11
1.5 18
ELECTROENCEPHALOGRAPHY(EEG)
1.6 26
ELECTROMYOGRAPHY(EMG)
1.7 29
ELECTROCULOGRAM(EOG)
1.8 31
PHONOCARDIOGRAM(PCG)
UNIT II
BIO-CHEMICAL AND NON ELECTRICAL PARAMETER MEASUREMENT
2.1
PH
34
2.2
PO2
35
2.3 36
PCO2
2.4 36
PHCO3
2.5 38
ELCTROPHORESIS
2.6
COLORIMETER
40
2.7 41
PHOTOMETER
2.8 43
AUTOANALYZER
2.9 43
BLOOD FLOW METER
2.10 50
CARDIAC OUTPUT
2.11
RESPIRATORY MEASUREMENT
52
2.12
BLOOD PRESSURE
57
2.13 TEMPERATURE 65
2.14 66
PULSE MEASUREMENT
2.15
BLOOD CELL COUNTERS
68
UNIT III
ASSIST DEVICES AND BIO-TELEMETRY
3.1
CARDIAC PACEMAKERS
71
3.2
DC DEFIBRILLATOR
75
3.3 80
TELEMETRY PRINCIPLES & BIO TELEMETRY
3.4 88
RADIO PILL AND TELESTIMULASTION
UNIT IV
RADIOLOGICAL EQUIPMENTS
4.1
IONISING RADIATION
89
4.2 93
DIAGNOSTIC EQUIPMENT
4.3 99
USE OF RADIO ISOTOPE IN DIAGNOSIS
4.4 101
RADIATION THERAPY
UNIT V
RECENT TRENDS IN MEDICAL INSTRUMENTATION
5.1
THERMOGRAPH
106
5.2
ENDOSCOPY UNIT
109
5.3 117
LASER IN MEDICINE
5.4
DIATHERMY UNITS
124
5.5 129
ELECTRICAL SAFETY IN MEDICAL EQUIPMENT
APPENDICES
A GLOSSARY
B QUESTION BANK
C UNIVERSITY QUESTIONS
EC2021 MEDICAL ELECTRONICS L T P 3 0 0 3
AIM
To make students to understand the applications of electronics in diagnostic and
therapeutic area.
OBJECTIVES
 To study the methods of recording various biopotentials
 To study how to measure biochemical and various physiological information
 To understand the working of units which will help to restore normal functioning
 To understand the use of radiation for diagnostic and therapy
 To understand the need and technique of electrical safety in Hospitals
UNIT I ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL

RECORDING 9
The origin of Bio-potentials; biopotential electrodes, biological amplifiers, ECG,
EEG, EMG, PCG, EOG, lead systems and recording methods, typical waveforms and
signal characteristics.
UNIT II BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

MEASUREMENT 9
PH, PO2, PCO2, PHCO3, Electrophoresis, colorimeter, photometer, Auto analyzer,
Blood flow meter, cardiac output, respiratory measurement, Blood
pressure, temperature, pulse, and Blood cell counters.
UNIT III ASSIST DEVICES AND BIO-TELEMETRY 9

Cardiac pacemakers, DC Defibrillator, Telemetry principles, frequency selection, Bio-
telemetry, radio-pill and tele-stimulation.
UNIT IV RADIOLOGICAL EQUIPMENTS 9

Ionizing radiation, Diagnostic x-ray equipments, use of Radio Isotope in
diagnosis, Radiation Therapy.
UNIT V RECENT TRENDS IN MEDICAL INSTRUMENTATION 9

Thermograph, endoscopy unit, Laser in medicine, Diathermy units, Electrical safety in
medical equipment.
TEXT BOOK
1. Leislie Cromwell, “Biomedical instrumentation and measurement”, Prentice
Hall of India, New Delhi, 2007.
REFERENCES TOTAL PERIOS:45

1. Khandpur, R.S., “Handbook of Biomedical Instrumentation”, TATA McGraw-Hill,
New Delhi, 2003.
2. Joseph J.Carr and John M.Brown, “Introduction to Biomedical
equipmentTechnology”, John Wiley and Sons, New York, 2004.
EC2021 MEDICAL ELECTRONICS
UNIT I
ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING
1.1 THE ORIGIN OF BIO-POTENTIALS:
 Bioelectric phenomenon is of immense importance to biomedical engineers because

these potentials are routinely recorded in modern clinical practice.
 ECG (Electrocardiogram), EMG (Electromyogram), EEG (Electroencephalogram), ENG
(Electroneurogram), EOG (Electro-oculogram), ERG (Electroretinogram), etc. are some
examples of biopotentials. We will briefly look at origin of ENG, EMG and ECG in this
talk.
 As engineers, we should have a good physical insight into the nature of electromagnetic
fields generated by bioelectric sources. Therefore we could contribute to quantitative
solution of biological problems.
To understand the origin of biopotentials we need to focus on:
 Bioelectric phenomena at the cellular level

 Volume conductor fields of simple bioelectric sources
 Volume conductor fields of complex bioelectric sources
 Volume conductor fields as a necessary link between cellular activity and gross externally
recorded biological signals
1.1.1 ELECTRICAL ACTIVITY OF EXCITABLE CELLS
 Biopotentials are produced as a result of electrochemical activity of excitable cells: i.e.,

nervous, muscular (cardiac and smooth) and glandular cells
Factors influencing the flow of ions across the cell membrane
 Diffusion gradients
 Inwardly directed electric field (inside negative, outside positive)
 Membrane structure (availability of pores; K+, Na+and permeability of membrane to
different ions)
 Active transport of ions across membrane against established electrochemical gradients
 When appropriately stimulated, they generate an action potential (flow of ions across the
cell membrane and generation of a propagating wave of depolarization along the
membrane)
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1.1.2 BIOELECTRIC PHENOMENA AT THE CELLULAR LEVEL
Figure 1.1 Recording of action potential
A very important topic in electrophysiology is the relationship between intracellular and

extracellular potentials, especially in nerve or muscle fibres .
Figure 1.2 Waveforms of intracellular action potential
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Figure 1.3 Waveforms of Extracellular action potential
The relation between extracellular potentials (A-E), transmembrane potential Vm(part F) and the
second derivative of Vm(part G).
Note:
The relationship between trans membrane (action potential) Vm (monophasic) and volume
conductor (extracellular field) potential d2Vm/dt2(triphasic). Students interested in the
biophysics of this topic should refer to: Bioelectic Phenomena by Robert Plonsey
Figure 1.4 Volume conductor fields of simple bioelectric sources
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Trans membrane (Et= Vm) and extracellular action potentials (Ex) obtained from different
excitable tissues. Note the monophasic and triphasic shapes.
a. Frog semitendinous muscle
b. Toad sartorius muscle
c. Rabbit atrium
d .Squid giant axon.
1.2 BIOPOTENTIAL ELECTRODES
Electrode – Electrolyte Interface
General Ionic Equations

C<->Cn+ +ne-
Am-<->A +me -
 If electrode has same material as cation, then this material gets oxidized and enters the
electrolyte as a cation and electrons remain at the electrode and flow in the external
circuit.
 If anion can be oxidized at the electrode to form a neutral atom, one or two electrons are
given to the electrode
The dominating reaction can be inferred from the following :
 Current flow from electrode to electrolyte : Oxidation (Loss of e-)

 Current flow from electrolyte to electrode : Reduction (Gain of e-)
Figure 1.5 Electrolyte Interface
Half Cell Potential
 A characteristic potential difference established by the electrode and its surrounding

electrolyte which depends on the metal, concentration of ions in solution and temperature.
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Half cell potential cannot be measured without a second electrode.
 The half cell potential of the standard hydrogen electrode has been arbitrarily set to zero.
Other half cell potentials are expressed as a potential difference with this electrode.
Reason for Half Cell Potential : Charge Separation at Interface
 Oxidation or reduction reactions at the electrode-electrolyte interface lead to a double-

charge layer, similar to that which exists along electrically active biological cell
membranes.
Measuring Half Cell Potential
Figure 1.6 Half Cell Potential
Polarization
 If there is a current between the electrode and electrolyte, the observed half cell potential
is often altered due to polarization.
Nernst Equation
 When two aqueous ionic solutions of different concentration are separated by an ion-
selective semi-permeable membrane, an electric potential exists across the membrane.
The Nernst equation for half cell potential is
E=E0 + RT/n[acyad/ aAαaBβ]
where E0 : Standard Half Cell Potential
E : Half Cell Potential
a : Ionic Activity (generally same as concentration)
n : Number of valence electrons involved
Polarizable and Non-Polarizable Electrodes
 Perfectly Polarizable Electrodes: These are electrodes in which no actual charge crosses
the electrode-electrolyte interface when a current is applied. The current across the
interface is a displacement current and the electrode behaves like a capacitor. Example :
Ag/AgCl Electrode
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 Perfectly Non-Polarizable Electrode: These are electrodes where current passes freely
across the electrode-electrolyte interface, requiring no energy to make the transition.
Over potentials. Example : Platinum electrode
Example: Ag-AgCl is used in recording while Pt is use in stimulation
Figure 1.7 Equivalent Circuit

Cd : capacitance of electrode-eletrolyte interface
Rd : resistance of electrode-eletrolyte interface
Rs : resistance of electrode lead wire
Ecell : cell potential for electrode
Electrode Skin Interface
Motion Artifact
 When the electrode moves with respect to the electrolyte, the distribution of the double
layer of charge on polarizable electrode interface changes. This changes the half cell
potential temporarily.
 If a pair of electrodes is in an electrolyte and one moves with respect to the other, a
potential difference appears across the electrodes known as the motion artifact. This is a
source of noise and interference in biopotential measurements.Motion artifact is minimal
for non-polarizable electrodes
Body Surface Recording Electrodes
Figure 1.8 Body surface Recording Electrodes

Commonly Used Biopotential Electrodes
Metal Plate Electrodes are
1. Suction Electrodes
2. Floating Electrodes
3. Flexible Electrodes
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Metal plate electrodes

– Large surface: Ancient, therefore still used, ECG
– Metal disk with stainless steel; platinum or gold coated
– EMG, EEG
– smaller diameters
– motion artifacts
– Disposable foam-pad: Cheap!
Figure 1.9 Metal plate Electrode
Suction electrodes
- No straps or adhesives required
- precordial (chest) ECG
- can only be used for short periods
Figure 1.10 Suction Electrode
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Floating electrodes
Double-sided
Adhesive-tape Electrolyte gel
ring in recess
(a) (b)
Snap coated with Ag-AgCl External snap
Gel-coated sponge
Plastic cup Plastic disk
Tack Dead cellular material

Foam pad
Capillary loops Germinating layer
(c)
Figure 1.11Floating Electrodes
- metal disk is recessed

- swimming in the electrolyte gel
- not in contact with the skin
- reduces motion artifact
Flexible electrodes
- Body contours are often irregular
- Regularly shaped rigid electrodes may not always work.
- Special case : infants
- Material :
- Polymer or nylon with silver
- Carbon filled silicon rubber (Mylar film)
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Figure 1.12 Flexible Electrodes
(a)Carbon-filledsiliconerubberelectrode.
(b)Flexiblethin-filmneonatalelectrode.
(c) Cross-sectional view of the thin-film electrode in (b).
Electrodes in Biopotential Measurements

• to make the electrode cheaper
• more suitable for lower noise measurement for EEG
• circumvent patents that are based on plastic/foam electrode body
• attractive to consumers for use with their ECG machines at home
• reduce artifact (minimize the motion of skin/electrode) in ambulatory recording
In a research laboratory, scientists want to record from single cells in a culture dish. They
want to record action potentials from single, isolated heart cells. What kind of electrode would
they need to use (describe material and design)? Give a simplified schematic (circuit model of
the electrode) described in the notes given to you.
Neural electrodes/microelectrodes
It is used to measure potential within asingla cell.It is small in diameter and during insertion
of microelectrode into cell will not damage to human cell.
 It is classified into
1. Metallic
2. Non metallic(Micropipet)
Metallic Electrode
 It is formed by electrolytically etching the tip of fine tungsten filament stainless

wire into a minute structure.
 Potential within the cell can be measured by using two electrodes
1. Micro electrode, 2. Reference electrode.
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Non Metallic (Micropipet)
 It is used to measure the potential within the single cell using non metallic
material is used.
 It is filled within an electrolyte ,that is compatible with the cellular fluids.
1.3 BIOPOTENTIAL AMPLIFIERS
 These are very important part of modern medical instrumentation. We need to

amplify biopotentials which are generated in the body at low levels with high
source impedance.
 Biopotentials amplifiers are required to increase signal strength while maintaining
fidelity
Basic Requirements of Biopotential Amplifiers
Essential functions of a bioamplifier are:

• To take a weak biopotential and increase its amplitude so that it can be processed,
recorded or displayed
• To amplify voltage, but it could be considered as a power amplifier as well.To amplify
current since in some cases a biopotential amplifier is used to isolate the load from the source
current gain only
Input Impedance (Zin)
• All biopotential amplifiers must have high input impedance minimize loading
(remember the characteristics of biopotential electrodes resulting into loading and distortion if
input impedance of the amplifier is not high enough) – typical values of Zin over the frequency
range of the measure and = 10 MΩ (remember the loading rule)
Protection & Isolation

• The input circuit of a biopotential amplifier must provide protection to the live measure
Vbio
• Any potential or current at amplifier’s input terminals can affect
Vbio
• Electric currents produced by the biopotential amplifier can result in microshock and
macro shock
• The bioamplifier must have isolation and protection circuitry so that the current through
the electrodes can be kept at safe levels and any artifact generated by such current can be
minimized
Output Impedance (Zout)
 The output circuit does not present any critical problems, all it needs to do is to drive the
load
 Output impedance must be low with respect to the load impedance and it must be capable
of satisfying the power requirements of the load
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Bandwidth (BW)
Frequency response
• The biopotential amplifier must be sensitive to important frequency components of the
biosignal
• Since biopotentials are low level signals, it is important to limit bandwidth optimize
signal-to-noise ratio
Gain (G)
• Biopotential amplifiers have a gain of 1000 or greater
Mode of Operation
• Very frequently biosignals are obtained from bipolar electrodes
• Electrodes symmetrically located with respect to ground need differential amplification
• High CMRR required because:
1. Common mode signals much greater than the biosignal appear on bipolar electrodes
2. Symmetry with respect to ground is not perfect (mismatch between electrode impedances) –
more on this later
Calibration Signal
 Medical and clinical equipment require quick calibration. The gain of the biopotential
amplifier must be calibrated to provide us with an accurate indication of the signal’s
amplitude
 Push button to apply standard signal to the input of the biopotential amplifier
 Adjustable gain switch carefully selects calibrated fixed gains.
1.4 ELECTROCARDIOGRAPHY (ECG)
 A very widely used medical instrument, which is utilized to diagnose and monitor cardiac
beat abnormalities, is the electrocardiograph.
 It measures the electrical activity of the heart (more precisely biopotential differences
arising from the electrical activity of myocardium). We’ve already talked about the
genesis of the ECG signal.
 The ECG machine uses surface electrodes and high input impedance
 Differential amplifiers with good common mode rejection ratio to record the
electrocardiogram
 Normal ECG amplitude ranges between 0.5-4 mV. Normal frequency content of ECG
(for diagnostic purposes) is 0.05-100 Hz. A typical ECG waveform is shown below:
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Significant diagnostic features of the ECG signal are:
 Duration of component parts of the signal

 Polarities and magnitudes
 The details of the ECG signal and the degree of variability in different parts of the ECG
signal is shown below:
Figure 1.13 ECG Signal
 The QRS amplitude, polarity, time duration, the RR interval (indicator of heartbeat per
min.) and the T-wave amplitude are some very important and distinctive features of the
ECG signal.
 The heart rate in BPM = Beats Per Minute) is simply = 60 (RR interval in seconds)
Some ECG waveform abnormalities that may indicate illness are:
 An extended PR interval may be diagnosed as AV node block

 A widening of the QRS complex may indicate conduction problems in the bundle of His
 An elevated ST segment may indicate occurrence of myocardial Infarction (MI)
 A negative polarity in the T wave may be due to coronary insufficiency
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1.4.1 ECG Leads
A Normal ECG recording for the standard lead connections leads I, II and III (Lead II
provides the strongest signal)
Figure 1.14 Normal ECG waveforms
Obviously, all human hearts are not the same and this results into a high degree of variability.
Some abnormalities that may indicate illness:
 An extended P-R interval may be diagnosed as AV node block

 Widening of the QRS complex conduction problems in the bundle of His
 Elevated ST segment may indicate occurrence of MI
 Negative polarity T wave may be due to coronary insufficiency QRS amplitude, polarity,
time domain, PR interval (indicator of heat beat per min. & T-wave amplitude are some
very important.
 Distinctive features.
1.Loss
Figure 1.15 ECG Abnormal waveforms
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2. Origin of the ECG signal
 We have already covered this concept extensively in the previous lectures (The Dipole
filed of the heart, the Eindhoven’s Triangle, the electrical circuit model for the
electrocardiographic problem, etc.)
Standard Limb Leads (I, II, III)
Figure 1.16 origin of ECG Signal
 The lead wires are color-coded according to some conventions. One example is: White –
RA (Right Arm), Black – LA (Left Arm), Green – RL (Right Leg), Red – LL (Left Leg),
and Brown – C (Chest)
Augmented Limb Leads
 These leads offer a free 50% increase over leads VR, VL, and VF connections (unipolar
leads) with respect to Wilson terminal AVR = -I – III/2, AVL = I – II/2, aVF = II – I/2
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Figure 1.17 Augmented Limb Leads
Each measurement is made from the reflected limb and the average of the other two limbs.
1.4.2 The ECG Machine

Most representative Specs:
• Zin = 10 MΩ
• Frequency response = 0.05 –100 Hz
• Strip Chart Recorder Speed = 25 mm/sec.
• Fast Speed = 100 mm/sec.
For detailed Specs. Refer to the Table in your text “Summary of performance requirements
for electrocardiographs”
Location of the Heart
• The heart is located between the lungs behind the sternum and above the diaphragm.
• It is surrounded by the pericardium.
• Its size is about that of a fist, and its weight is about 250-300 g.
• Its center is located about 1.5 cm to the left of the midsagittal plane.
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Figure 1.18 Location of Heart
Anatomy of the heart

• The walls of the heart are composed of cardiac muscle, called myocardium.
• It consists of four compartments:
– the right and left atria and ventricles
The Heart Valves

• The tricuspid valve regulates blood flow between the right atrium and right ventricle.
• The pulmonary valve controls blood flow from the right ventricle into the pulmonary
arteries
• The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the
left ventricle.
• The aortic valve lets oxygen-rich blood pass from the left ventricle into the aorta, then to
the body.
Figure 1.19 Heart Valves
Blood circulation via heart

• The blood returns from the systemic circulation to the right atrium and from there goes
through the tricuspid valve to the right ventricle.
• It is ejected from the right ventricle through the pulmonary valve to the lungs.
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• Oxygenated blood returns from the lungs to the left atrium, and from there through the
mitral valve to the left ventricle.
• Finally blood is pumped through the aortic valve to the aorta and the systemic
circulation.
Electrical activation of the heart
• In the heart muscle cell, or myocyte, electric activation takes place by means of the same
mechanism as in the nerve cell, i.e., from the inflow of Na ions across the cell membrane.
• The amplitude of the action potential is also similar, being 100 mV for both nerve and
muscle
• The duration of the cardiac impulse is, however, two orders of magnitude longer than in
either nerve cell or sceletal muscle cell.
• As in the nerve cell, repolarization is a consequence of the outflow of K ions.
• The duration of the action impulse is about 300 ms
Mechanical contraction of Cardiac Muscle
• Associated with the electric activation of cardiac muscle cell is its mechanical
contraction, which occurs a little later.
• An important distinction between cardiac muscle tissue and skeletal muscle is that in
cardiac muscle, activation can propagate from one cell to another in any direction.
• Electrical signal begins in the sinoatrial (SA) node: "natural pacemaker." causes the atria
to contract.
• The signal then passes through the atrioventricular (AV) node.
– sends the signal to the ventricles via the “bundle of His”
– Causes the ventricles to contract.
The Conduction System
Figure 1.20 Conduction System
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The Action Potential
Figure 1.21 Action Potential
Recording an AP requires the isolation of a single cell.
 Microelectrodes (with tips a few μm across) are used to stimulate and record the
response. A typical AP is 2-4ms long with an amplitude of about 100Mv
1.5 ELECTROENCEPHALOGRAM (EEG)
 EEG is the recorded representation of bioelectric potentials generated by the neuronal

activity of the brain.
 Basically, the brain is a gelatinous mass suspend in the meanings, the cerebrospinal fluid,
skull and scalp.
 The brain is composed of three major subdivisions:
1. Cerebellum,
2. Brainstem
3. (Medulla, pons, midbrain, diencephalon) and
4. Cerebrum
The cerebellum is mainly involved with skeletal muscle functions and maintenance of balance. It
coordinates smooth and directed movements.
 The brain stemis the stalk of the brain and serves as a relay station for all afferent
(sensory) and efferent (motor) nerve fibers between the spinal cord and higher brain
canters. It also gives rise to ten of the twelve cranial nerves, which supply the muscles and
glands of the head and major organs in the thoracic and abdominal cavities
 Throughout the entire brainstem runs a core of tissue called the reticular formation, which
serves as a highly complex cluster of neurons involved in integration of information from
many afferent pathways as well as from numerous other parts of the brain.
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 The cerebrum consists of the right and left hemispheres. The outer part of the cerebral
hemispheres, the cerebral cortex, is a cellular shell 1.5 – 4 mm thick of grey matter.
 The cerebral cortex is highly convoluted and is the most complex integrating center of the
nervous system. It brings together basic sensory information into meaningful perceptual
images and formulates ultimate decisions for control over the motor systems of the body.
 The cerebral cortex is comprised of two layers: the pale cortex and the neocortex.
 The pale cortex is located on the median surface and the base of the brain and the
neocortex is present on the superior and lateral aspects of the cerebral hemispheres.
 The neocortex is composed of six layers and its cells can be categorized as pyramidal and
non-pyramidal cells. There are approximately 1010 neurons in the human cerebral cortex,
about 75% of, which is pyramidal.
 Pyramidal cells, named originally after their shape, have several
characteristics. Their cell bodies are commonly triangular in shape, with the base down
and the apex directed toward the cortical (superficial) surface.
 The cell bodies vary in size, from axial dimensions of 15 x 10 μm up to 120 x 90 μm. A
typical pyramidal cell consists of a long apical dendrite, about 2 mm long, that ascends
from the apex of the cell body and enters the overlaying layers and terminally branches
within the outermost layer of the neocortex.
 There is a dominant apical dendrites tree, looking like a forest of
similarly oriented, densely packed units in the superficial layers of the neocortex, where
extensive branching occurs.
Figure 1.22 EEG

 There is also a basilar dendritic system that extends out spherically from the cell body.
 Pyramidal cells also have an axon that emerges from the cell body and enters the sub
cortical white matter.
 The axons of all pyramidal cells terminate in excitatory synapses. The initial segment of
pyramidal cells is unmyelinated,as their recurrent branches
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 Axons of some pyramidal cells turn back toward the cortical surface to end via their many
dendritic branches on the dendrites of other cells.
 It has been shown by electrophysiological studies that under normal circumstances,
propagating action potentials in axons do not contribute significantly to surface cortical
recordings.
 There reason being that action potentials travel in large number of axons (running in
many different directions relative to the surface) in a temporally a synchronized way.
Therefore, their net contribution to the surface EEG is minimal and negligible.
 It has been shown that the vertically oriented pyramidal cells with their long apical
dendrites running parallel to one another are the major contributors to the electro genesis
of the cortical field potentials (EEG signal).
Figure 1.23 Cerebrum
A highly schematic representation of a pyramidal cell and its role in the generation of surface
EEG signal. Let’s consider a single pyramidal cell, and explain how potential changes in one part
of the cell relative to other parts could generate the EEG signal.
 Excitatory synaptic inputs to the branches in the apical dendritic tree of the pyramidal
cells cause depolarization of the dendritic membrane.
 This leads into generation of an excitatory postsynaptic potential (EPSP)
 As a result, a radially oriented dipole is set up and sub threshold current flows in a closed
path through the cytoplasmic core of the dendrites and cell body of the cell, returning to
the synaptic sites via the conducting extracellular medium
 The lines of current flow make the extracellular medium close to the cell body act as a
source with + polarity and the upper part of the apical dendritic tree to act as a sink with –
polarity.
 This leads into recording a negative potential at the cortical surface
 In case of inhibitory synaptic inputs to the branches in the apical
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dendritic tree, an inhibitory postsynaptic potential (IPSP) is generated with a reversal in

the polarity of the current dipole, which leads into a generation of a positive cortical
recording.
 Therefore, the influence of a particular dendritic postsynaptic potential on the cortical
recording depends on its net excitatory or inhibitory effect and on its location relative to
the measurement site.
The EEG (electroencephalogram) signal is a recording of the electrical activity of the brain.
The EEG signal recorded at the cortex or the scalp is generated by the polled activity of billions
of cortical and sub cortical regions. The origin of the EEG signal is based on the electrical
activity of the pyramidal cells. The EEG potentials primarily reflect the summated fluctuations of
excitatory and inhibitory postsynaptic potentials in the pyramidal cells of the upper layers of the
cerebral cortex. For reasons of geometry as well as because of extreme extracellular attenuation,
action potentials from firings of pyramidal cells contribute only minimally or not all to the
generation of the EEG signal.
 All we need to contend ourselves with at this stages that the EEG or brain waves are
summation of neural depolarization sin the brain due to the stimuli from the five senses as
well as from thought processes (indeed a very complex source). More on this in
physiology in the Nervous System topic.
 EEG potentials have random-appearing waveforms with peak-to-peak amplitudes ranging
from less than 10 mV to over 100mV. Required bandwidth is from below 1 Hz to over
100 Hz.
EEG is recorded with 3 types of electrodes:

1. Scalp
2. Cortical Electrocardiogram (recording from surface of cortex)
3. Depth Electrodes recording from depth of brain (thin insulated needles of various designs)
 No matter where the recording is obtained from (scalp, cortex or depth of the brain), the
fluctuating potentials represent a superposition of the volume conductor fields produced
by a huge variety of active neuronal current-generators.
 On the surface of the brain (i.e. Electrocardiogram), we can record voltages on the order
of 10 mV! But, typical EEG electrodes measure the electrical activity propagated through
skull bone and is attenuated from 1 to 100 μV.
 EEG potentials vary as a function of position over the surface of the skull, making it
necessary to select sets of electrodes grouped around Frontal, Parietal, Temporal and
Occipital lobes.
The EEG Signal
 The character of the EEG signal is highly dependent on the degree of the activity of the
cerebral cortex, i.e. waves change markedly between states of wakefulness and sleep.
 Much of the time, EEGs are irregular and no general pattern can be observed. Other
times, distinct patterns emerge
 The EEG waveform is divided into four wave groups:
1. The Alpha Waves (α) 8-13 Hz
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2. The Beta Waves (β) 14-30 Hz (The Gamma Waves (γ) 22-30 Hz or higher)
3. The Theta Waves (θ) 4-7 Hz
4. The Delta Waves (δ) <3.5 Hz
Note: During periods of mental activity, the waves usually become asynchronous rather than
synchronous, so the magnitude of summed potentials decreases in spite of cortical activity.
 In general there is a relationship between cerebral activity and the frequency of the EEG
rhythm
 Frequency increases progressively with higher degrees of activity
Figure 1.24 EEG waveform
Examples:
 δ-Waves(<3.5 Hz) occur in surgical anesthesia and sleep

 θ-Waves(4-7 Hz) occur in emotional stress and frustration
 α-Waves(8-13 Hz) occur during relaxed states
 β-Waves(14-30 Hz)occur during intense mental activity
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Figure 1.25 Different EEG waveforms
The EEG changes that occur as a human subject goes to sleep.
EEGs in Diagnosis
The purpose of the clinical EEG is to help neurologists diagnose disease. The pathological
states most commonly diagnosed using EEG are:
 Brain death (legal death)

 Brain tumors
 Epilepsy
 Multiple Sclerosis
 Sleep Disorder
 Evoked responses (diseases of the audio, visual and tactile senses)
 Modern life sustaining equipment like respirators, kidney dialyzers, ventilators, artificial
heart pumps have changes the definition of death
 A sustained absence of EEG signal is a clinical measure of brain death and can be used in
deciding whether to transplant a heart, liver, or lung or whether to shut down the life
sustaining equipment
Some Representative Abnormal EEGS
Petit mal epilepsy– Minor for of seizure, clouding of consciousness and loss of contact with the
environment
Grand mal epilepsy– Sudden loss of consciousness, falling down, tonic contractions (stiffening
of muscles) followed by twitching and jerking movements of the limbs
Psychomotor seizures are parietal seizures characterized by: semi-purposeful movements,

changes in consciousness, hallucinations and illusions.
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Figure 1.26 Abnormal EEGs
EEG Electrode Positions
 In electroencephalography, the electrodes are placed in an arrangement referred to as the

10-20 system
 This is a placement scheme devised by the International Federation of Societies of
Electroencephalography
 The electrodes are placed along a line drawn on the skull from the root of the nose, the
nasion, to the classification (bump on the occipital lobe)
 The first mark is placed 10% of the distance along this line and others are arranged at
20% intervals
Figure 1.27 EEG Electrode position

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Electroencephalograph Signal Path
The EEG signal path is comprised of: Scalp (biosignal source) EEG electrodes , Junction
box ,channel selector , differential amplifier, bank filters, display .
Figure 1.28 Block diagram of Electroencephalograph Signal Path
 It shows the modern 8 channel EEG recorder. The patient cable consists of 21 electrodes
and is connected to the 8 channel selector.
 The electrodes are attached to the channel selector in groups of 8 called a montage of
electrodes.
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 The right ear electrode acts as reference electrode for the right brain electrodes and left
ear electrode act as reference electrode for left brain electrodes.
 The 50 Hz interference is reduced by employing differential amplifiers as preamplifiers
with more than 80 dB CMRR and by use of 50 Hz notch filters.
 The effect of notch filter on signal distortion is not so much because important EEG
signals have frequencies below 30 Hz.
 The output voltage from the amplifier may either be applied directly to the eight channel
display through the filter bank or it may be stored as data on a tape recorder or in a
computer memory for further processing.
1.6 EMG (ELECTRO MYOGRAPH)
It is an instrument used for recording the electrical activity of the muscles to determine
whether the muscle is contracting or not. Study of neuromuscular function is also possible by
using EMG. Muscular contractions are caused by the depolarization of muscle fibers. Similarly
the recording of peripheral nerves action potentials is called as electro neurography.
ELECTRODES USED FOR EMG
Two types of electrodes:
Surface electrodes- Usually this electrode is used for EMG. But by using this electrode,
it is not possible to take the deeper potential.
Needle electrodes – These are inserted into tissue or closer to tissue to measure the
electrical activity of muscle.
EMG RECORDING SYSTEM
EMG potentials are taken from the tissue by using electrodes. These EMG potentials are
given to differential amplifier. This is the high gain amplifier. Its frequency range is given as 10
Hz to 10 KHz.
Bandwidth of EMG is large. CMRR (Common mode Rejection Ratio) of this differential
amplifier is 80 to 100 db.Input Impedance of this amplifier is 10 MΩ. Here there is no lead
selector switch. Because only two electrodes are available. The output of the differential
amplifier is given to loudspeaker system, tape recorder and CRO.
Before giving the output of differential amplifier to loudspeaker, it is given to power

amplifier. Power amplifier amplifies the signal that is received by loudspeaker.
The amplified signal from the output of the differential amplifier is displayed by using
CRO. Here storage oscilloscope is used. Output cab be displayed and the same can be stored in
the CRO. The signal from the differential amplifier is recorded by using tape recorder. It is used
for the future purpose.
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Figure 1.29 EMG Recording System
MEASUREMENT OF CONDUCTION VELOCITY IN MOTOR NERVES
In modern EMG systems, nerve conduction time and nerve velocity are measured. For
this measurement, initially nerve is stimulated and EMG is measured.This conduction velocity
measurement is used to indicate the location and type of nerve lesion.
Steps involved in measurement of conduction velocity
 Stimulte is applied at point A

 Electrical activity of muscle is measured at point B
 The space between A and B is noted as l1 meters.
 The time delay between applying stimulus and receiving action potential is known as
latency. This time delay is detoned as t1 second.
 Now change the position of A into C. Now the space is reduced. It is noted as l2 meters.
 The time delay noted is t2 second.
 Usually, l2<l1 and t2 <t1.
 Now , the conduction velocity is given as , V= l1-l2/t1-t2.
 Usually V= 50 m/sec.
 If V<40 m/s. It means there is some disorder in nerve conduction.
 Thus conduction velocity is measured in motor nerves.
 Skeletal muscle is organized functionally on the basis of the motor unit.
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Figure 1.30 Conduction Velocity In Motor Nerves
Single Motor Unit (SMU)
 The motor unit is the smallest unit that can be activated by a volitional effort (all
constituent muscle fibers are activated synchronously)
 Single motor unit (SMU) consists of a single motor neuron and the group of skeletal
muscles that it innervates
 SMU is a distributed unit bioelectric source in a volume conductor consisting of all other
muscle fibers, both active and inactive.
 The evoked extracellular field potential from the active fibers of an SMU has a triphasic
form of 3-15 ms duration and 20-2000 μV amplitude depending on the size of SMU
 The figure below shows motor unit potentials from normal muscle under graded levels of
contraction. At high levels of activity, many sophisticated motor unit responses give rise
to a complicated response (interference pattern)
Figure 1.31 EMG Recording

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 A variety of electrodes have been developed for EMG recording

 The figure below shows the needle and wire electrodes used in recording the EMG signal
 The EMG is also of considerable clinical value
 The shape of SMU potentials is modified by disease
The figure below shows the EMG response for a normal subject and one with neuropathy
Figure 1.32 EMG response of a normal and an abnormal waveforms
Applications of EMG:
EMG is used in the field of:

 Electrophysiological testing.
 Clinical neurophysiology.
 Neurology.
 Psychiatry.
1.7 EOG (ELECTROCULOGRAM)
EOG is the recording of the biopotentials generated by the movement of eyes. Here,
corneal-retinal potentials associated with eye movement is recorded. Electrode used in EOG:
surface electrodes are used to measure EOG.
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Figure 1.33 EOG Waveforms
Figure 1.34 Recording of Electroculogram
EOG MEASUREMENT
 Block diagram of EOG measurement system is shown. In the figure, position of

electrodes is shown.
 One pair of electrodes is placed above and below the nose. These electrodes are
used to measure the vertical movement of eye. The signals from these two pairs of
electrodes are given to the amplifier.
 Another pair of electrodes is placed in the left side and right side of the eye.
Horizontal movement of an eye is measured by using these electrodes.
 The signals from these electrodes are given to the amplifier circuit.
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Applications of EOG
 The effect of some drugs on the eye movement systems can be identified by
using EOG.
 It is used to analyze the state of semicircular canals.
 Diagnosis of the neurologic disorders is possible.
 The level of anesthesia can be indicated by the characteristic of eye
movement
1.8 PCG (PHONO CARDIOGRAM)
The graphical record of heart sound is known as Phono Cardiogram. Here Cardio
means the heart. The device which is used to measure heart sound is known as phonocardiograph.
Auscultation: The technique of listening sound produced by organs and vessels of the body is
known as auscultation.
In PCG, different types of heart sounds are measured. These heart sounds are due to the
vibrations set up in the blood inside the heart by the sudden closure of valves. In abnormal heart
additional sounds are heard between the normal heart sound. These additional sounds are known
as murmurs.Murmers is generally caused by improper opening of the valves or by regurgitation.
CLASSIFICATION OF HEART SOUND
It is divided into four types
 Valve closure sound

 Ventricular filling sound
 Valve opening sound
 Extra cardiac sound
Valve closure sound
This sound occurs at the beginning of systole and at the beginning of diastole.
Ventricular filling sound
This sound is occurred at the time of filling of the ventricles.
Valve opening sound
This sound occurs at the time of opening of atrioventricular valves and semi lunar
valves.
Extra cardiac sound
This sound occur in mid systole or late systole or early diastole
Systole: The contraction of the heart muscle. The systolic pressure is 120mm of Hg.
Diastole: The relaxation of the heart muscle. The diastolic pressure is 80 mm of Hg.
1.8.1 PCG RECORDING SYSTEM
Microphone is used to convert heart sound into the electrical signals. Certain positions are
recommended to pick up the heart sound by using microphone. The electrical signal picked up by
the microphone is amplified by the amplifier block. The amplified output is given to filter block.
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Condenser Output unit

Amplifier Filter
microphone
FM tape
ECG ECG recorder
electrode amplifier
Figure 1.35 Block Diagram of PCG Recording System
Figure 1.36 Characteristics and Filter circuit
Here high pass filter is used. Its cut of frequency is 1 kHz. Here ECG electrode system
and ECG amplifiers are usedfor reference for PCG. So ECG and PCG outputs are connected to
FM tape recorder and output display unit.
TYPES OF MICROPHONES USED IN PCG
1. Air coupled microphone- Movement of chest is transferred through the air cushion. It
provides low mechanical impedance to the chest.
2. Contact microphone – it is directly coupled to the chest wall and provides high
impedance, high sensitivity, and low noise. Its light weight is also one of the
advantageous factor.
The first heart sound is developed during the opening of aortic valve and during the closing of
mitral valve
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PCG waveform
Frequency of first heart sound consists of 30 to 45 Hz. Second heart sound is usually
higher in pitch than the first. Its frequency range is 50Hz to 70 Hz. Third heart sound is extremely
weak vibrate sound is extremely weak vibration. Its frequency is below 600 Hz.
Aortic stenos are murmur occurred when the blood is ejected from the left ventricle
through aortic valve due to resistance to ejection, the pressure in the left ventricle increased. So
turbulent blood flow occur.This turbulent blood impinging the aortic valve. So intense vibration
is produced. It produces loud murmur.
Mitral regurgitation murmur- In this murmur, blood flows in backward direction through the
mitral valve during systole.
Aortic regurgitation murmur – During diastole, sound is heard. In diastole blood flows in the
backward direction from aorta to left ventricles when valves are damaged, then this sound is
heard.
Mitral stenosis murmur – This murmur is produced when blood is passed from left atrium to
left ventricle. This sound is very weak.
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UNIT II
2.1 PH MEASUREMENT
The chemical balance in the body can be determined by the ph value of blood and other
body fluids.ph is defined as the hydrogen ion concentration of a fluid. It is the logarithm of the
reciprocal value of h+ concentration. The ph equation is given as,
Ph= - log10 [H+] = log10 1/[H+ ]
pH is the measure of acid- base balance in a fluid, A neutral solution has the ph value as 7.
Solutions with pH value less than 7 are acidic and above 7 are basic. Most of the body fluids are
slightly basic in nature.
Construction and working
The ph meter is made up of a thin glass membrane and it allows only the hydrogen ions
to pass through it. The glass electrode provides a membrane interface for H+ ions. The glass bulb
at the lower end of the ph meter contains a highly acidic buffer solution. The glass tube consists
of a sliver-sliver chloride (Ag/Agcl) electrode and the reference electrode which is made up of
calomel sliver-sliver chloride(Ag/Agcl) is tan placed in the solution in which ph is being
measured.
The potential is measured across the two electrodes. The electrochemical measurement,
which should be obtained by each of the electrodes called half- cell. The electrode potential is
called as half-cell potential. Here the glass electrode inside the tube constitutes one half –cell and
the calomel or reference electrode is considered as the other half-cell.
Figure 2.1 pH Electrode
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For easier ph measurement combination electrodes are used. In this type both the active
glass electrode and reference electrode are present in the same meter. The glass electrodes are
suitable only to measure ph values around 7. Since this type of glass electrodes produce
considerable errors during the measurement of high Ph values, special type of Ph electrodes are
used. After every measurement the pH meter is washed with 20% ammonium biflouride solution,
for accurate results. The Ph meter with hydroscopic glass absorbs water readily and provides best
pH value.
2.2 pO2 MEASUREMENT
The term po2 is defined as the partial pressure of oxygen respectively. The determination
of po2 is one the most important physiological chemical measurement. The effective functioning
of both respiratory and cardiovascular system can be by po2 measurement. The partial pressure of
a gas is proportional to the quantity of that gas present in the blood.
The platinum wire, which is an active electrode, is embedded in glass for insulation and
only its tip is exposed. It is kept in the electrolyte solution in which the oxygen is allowed to
diffuse. The reference electrode is made up of silver-silver chloride (Ab/AgCl). A voltage of 0.7
is applied between the platinum wire and the reference electrode. The negative terminal is
connected to the active electrode through a micro ammeter and the positive terminal is given to
the reference electrode.
Figure 2.2 pO2 Electrode
Due to the negative terminal, the oxygen reduction takes place at the platinum cathode.
Finally the oxidation reduction current proportional to the partial pressure of oxygen diffused into
the electrolyte can be measured in the micro ammeter. The electrolyte is generally scaled in the
electrode chamber by means of a membrane through which the oxygen can diffuse from the
blood or sample solution.
There are two types of pO2 measurement. They are
I) Vitro measurement
II) Vivo measurement
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In case of dark electrode the platinum cathode and the reference electrode is present in a single
unit. This electrode is used for vitro and vivo measurements.
In Vitro Measurements
In this method the blood sample is taken and the measurement for oxygen saturation is
made in the laboratory. The electrode is placed in the sample blood solution and the pO2 value is
determined.
In Vivo Measurements
In this method the oxygen saturation is determined while the blood is flowing in the
circulatory system. A micro version of the pO2 electrode is placed at the tip of the catheter so that
it can be inserted into various parts of the heart or circulatory system.
The pO2 measurement also has some disadvantages in it. The reduction process in the
platinum cathode removes a finite amount of the oxygen from the cathode. And there is a gradual
reduction of current with respect to time. However careful design and proper procedures in
modern pO2 electrodes reduce the errors.
2.3 pCO2 MEASUREMENT
The term pco2 is defined as the partial pressure of carbon dioxide respectively. The
determination of pco2 is one the most important physiological chemical measurement. The
effective functioning of both respiratory and cardiovascular system can be by pco2 measurement.
The partial pressure of a gas is proportional to the quantity of that gas present in the blood.
The partial pressure of carbon dioxide can be measured with the help of pCO 2 electrodes.
Since there is a linear relationship between the logarithm of pCO2 and pH of a solution. The
pCO2 measurement is made by surrounding a pH electrode with a membrane selectively
permeable to CO2.
The modern improved pCO2 electrode is called as severinghous electrode. In this

electrode the membrane permeable to CO2 is made up of Teflon which is not permeable to other
ions which affects the pH value. The space between the Teflon and glass contains a matrix layer
which allows only the CO2 gas molecules to diffuse through it.
One of the demerits in older CO2 electrode is, it requires a length of time for the CO2
molecules to diffuse through the membrane. The modern CO2 electrode is designed in such a way
to overcome this demerit. Here the CO2 molecules diffuse rapidly through the membrane and the
measurement can be done easily.
2.4 MEASUREMENT OF PHCO3
 Blood gas analyzers are used to measure the content of pH, pCO and PO2 from the
blood.
 Two gases of accurately known O2 and CO2 percentages are required for
calibrating the analyzer in pO2 and pCO2 modes. These gases are used with
precision regulators for flow and pressure control.
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 Two standard buffers of known pH are required for calibration of the analyzer in
the pH mode.
 Input signal to the calculator is obtained from the outputs of the pH and pCO 2
amplifiers
 The outputs are adjusted by multiplying with a constant and are given to an adder
circuit
 The output of adder is passed to antilog generators circuit. Then it is passed to
A/D converter for display. Resistance R is used to adjust zero at the output.
 Total CO2 is calculated by summing the output signals of the calculators and the
output of the pCO2 amplifier
Figure 2.3 circuit diagram of computation of bicarbonate
The base excess calculator consists of three stages.
In the first stage, the output of pH amplifier is inverted in an operational amplifier, whose
gain is controlled by a potentiometer.
Figure 2.4 Circuit diagram for computation of base excess
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The output of HCO3—calculator is inverted in the second stage.

The third stage is a summing amplifier A3 whose output is given to A/D converter, that gives a
digital read out.
2.5 ELECTROPHORESIS
In clinical laboratories, various devices are used based on the electrophoretic principle.
These devices are used for the following applications.
 To measure the quantity of protein in plasma, urine, etc.

 To separate enzymes into their components is enzymes.
 To identify antibodies.
Basic principle
Electrophoresis is defined as the movement of a solid phase with respect to a liquid. The
buffer solution is used to carry the current and to maintain the pH value of the solution as a
constant one during the migration.
In this title, zone electrophoresis is explained. In this technique, the sample is applied to
the medium and under the effect of the electric field, group of particles that are similar in charge,
size, and shape migrate at the same rate. So the particles are separated into zones.
Factors Affect the Speed of Migration
Magnitude of charge:
The mobility of a given particle is directly related to the net magnitude of the particles
charge. Mobility is defined as, the distance in cm, a particle moves in unit time per unit field
strength.
Ionic Strength of Buffer
If the buffer is more concentrated then the migration of the particles is slow. Because, if
greater the proportion of buffer ions present, then greater the proportion of the current they carry.
Temperature:
Mobility is directly related to temperature. Heat is produced when the current flows
through the resistance of the medium. So, the temperature of the medium is increased and
resistance is decreased. Finally, the rate of migration is increased.
The water is evaporated from the surface of the medium due to heat. So, the concentration
of particle is increased. Finally the rate of migration is increased. When the gel is used as a
medium; this heat will create a problem. So, for this medium, constant current sources are used to
minimize the heat production.
Time: The distance of migration is related to the time period during which electrophoresis takes
place.
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Types of Support Media:
Cellulose acetate, starch gel and sucrose are used as support media in various
electrophoretic applications. We can see the cellulose acetate electrophoresis in the following
sections.
Cellulose Acetate Electrophoresis
Cellulose acetate strip is saturated with the buffer solution and placed in the membrane
holder. It is otherwise known as bridge. The two ends of the bridge are placed in the cuvette in
which buffer solution is available.
The sample for each test is placed on the strip at a marked location. Then, the constant
electric potential(250 V) is applied across the strip 4 – 6 mA of initial current is obtained .After
15-20mins, the electric voltage is removed, then, migrated protein band is stained with buffer
and it is dried in preparation for densitometry.
Figure 2.5 Pattern
The membrane is placed in the holder of densitometer. The path of the migration of
one of the specimen is scanned. The low voltage output is amplified and recorded using x-y
recorder.
Figure2.6 Cellulose acetate electrophoresis
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2.6 COLORIMETER
 Measures the color concentration of a substance in a solution by detecting the color light
intensity passing through a sample containing the substance and a reagent
 Optical color filters are used to detect the color wavelength of interest. E.g., urine passes
yellow light and absorbs blue and green
 Laser LEDs are preferred if their wavelength is suitable due to purity of the
monochromatic color.
Figure2.7 Colorimeter
Figure2.8 Concentration vs Absorbance
Transmittance
T= I1/I0 * 100%
Absorbance
A= - log I1/ I0
A=log 1/T
If the path length or concentration increases, the transmittance decreases and absorbance
increases, a phenomenon expressed by Beer’s Law.
Absorbtivity related to the nature of the A=aCL absorbing substance and optical
wavelength (known for a standard solutionconcentration).
C: Concentration
L: Cuvette path length
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2.7 PHOTOMETER
2.7.1 FLAME PHOTOMETER
Figure2.9 Flame Photometer
Measures the color intensity of a flame supported by O2 and a specific substance.

Sample’s emission of light is measured (rather than the absorbance of light).Typically used to
determine the conc. of pure metals and/or Na+, K+, Li+ and Ca++
In this method, fine droplets of the sample is aspirated into gas flame that burns in a
chimney. A known amount of lithium salt is added to the sample, as a reference. As a result, red
light is emitted by the lithium and yellow and violet beam are emitted due to sodium and
potassium respectively. These diffracted colours are made to incident on photodiodes. The photo
detector circuits consists of a reverse biased diode in which the current flow increases as intensity
of incident light increases. A calibration potentiometer is used in every channel. Since the lithium
is used as a standard reference, the output of sodium and potassium channel are calibrated in
terms of differences with the known lithium. The output can be compared with the spectral
illustration.
2.7.2 SPECTROPHOTOMETER
 The general name given to the group of instruments whose principle of operation is
based on the fact that substances of clinical interest selectively absorb or emit EM
energy (light) at different wavelengths.
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 Depending on the substance being measured, the wavelength used is typically in the
ultraviolet (200-400 nm), visible (400-700nm) or infrared (700 to 800 nm) range.
 Spectrophotometer can be used to determine the entity of an unknown substance, or the
concentration of a number of known substances.
 The type of source / filters used typically determines the type of the spectrophotometer.
 Rays of light bend around sharp corners, where the amount of bending depends on the
wavelength! This results in separation of light into a spectrum at each line.
 In spectrophotometer, selection filter of colorimeter is replaced by a monochromator.
Monochromatic uses a diffraction grating G to disperse light from the lamp. Light falls
through the slit S0 into its spectral components.
 Slit S1 is used for selecting a narrow band of the spectrum which is used to measure the
absorption of a sample in the cuvette.
 The light from the cuvette is given to photo detector. It converts light into a electrical
signal. This electrical signal is amplified by using an amplifier. The output from the
amplifier is given to meter which shows absorbance.
 Light absorption is varied when the wavelength is varied. Mirror M is used to reduce the
size of the instruments.
Figure 2.10 Spectrophotometer
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2.8 AUTOANALYZER
An auto analyzer sequentially measures blood chemistry through a series of steps of mixing,
reagent reaction and colorimetric measurements.
Itconsists of
 Sampler: Aspirates samples, standards, wash solutions into the system
 Proportioning pump: Mixes samples with the reagents so that proper chemical color
reactions can take place, which are then read by the colorimeter
 Dialyzer: separates interfacing substances from the sample by permitting selective
passage of sample components through a semi permeable membrane
 Heating bath: Controls temperature (typically at 37 °C), as temp is critical in color
development
 Colorimeter: monitors the changes in optical density of the fluid stream flowing through
a tubular flow cell. Color intensities proportional to the substance concentrations are
converted to equivalent electrical voltages.
 Recorder: Displays the output information in a graphical form.
Figure 2.11 Block diagram of Autoanalyzer
2.9 BLOOD FLOW METER
Blood flow meters are used to monitor the blood flow in various blood vessels and to
measure cardiac output.
Types
 Electromagnetic blood flow meters

 Ultrasonic blood flow meters
 Laser based blood flow meters
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2.9.1 ELECTROMAGNETIC FLOWMETERS

 Electromagnetic blood flow meters measure blood flow in blood vessels
 Consists of a probe connected to a flow sensor box
Figure 2.12 Blod flow meter
An Electromagnetic Flow Meter is a device capable of measuring the mass flow of a

fluid. Unlike the common flow meter you can find on the market it has no moving
parts, and for this reason it can be made to withstand any pressure (without
leakage)and any fluid(corrosive and non corrosive). This kind of flow meter use a
magnet and two electrodes to peek the voltage that appears across the fluid moving in
the magnetic field.
Figure 2.13 Electromagnetic Flowmeter
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The Neumann Law (or Lenz Law) states that if a conductive wire is
moving at right angle through a magnetic field, a voltage E [Volts] will appear
at the end of the conductor (Fig.1):
E=B*L*V
Where
B = Magnetic Induction
[Weber/m2]
L = Length of the portion of the wire 'wetted' by the
magnetic field [m]
V = Velocity of the wire [m/sec]
Figure 2.14 Magnetic Blood flowmeter priciple
Now imagine you have a plastic tube with two electrodes on the diameter and
Mercury flowing into it (fig.2). A voltage will appear on the electrodes and it will be
E=B*L*V
As in the previous example (L in this case is the inner diameter of the tube).Mercury as
tiny conductive wires next to each other: each wire, moving in the tube, will touch the two
electrodes ,and thus you can measure their voltage.
An interesting fact is that if you reverse the flow, you still get a voltage but with
reverse polarity (Fig.1). Till now we have talked about a conductive fluid ,Mercury, but
this stuff will also work with non conductive fluid, provided that you use an alternating
magnetic field. Two physicists, Middleman and Cushing, in an unpublished work, stated that
when using a non conductive fluid, if the frequency of the alternating magnetic field is v the
voltage at the electrodes will be attenuated by a factor a so that:
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Measuring the flow
`A perfect axisimmetric construction cannot be achieved and thus some

magnetic flux lines will 'wet' the connecting wires to the electrodes. The alternating
magnetic field will create an offset voltage in this wire and even if the fluid is not
moving, the measured voltage will not be zero.
2.9.2 ULTRASONIC FLOWMETERS
The blood cells in the fluid scatter the Doppler signal diffusively.In the recent years
ultrasound contrast agents have been used in order to increase the echoes.The ultrasound beam is
focused by a suitable transducer geometry and a lens.
Figure 2.15 Ultrasonic flowmeters
fd = 2fcv/c
f = 2- 10 MHz
c = 1500 - 1600 m/s (1540 m/s)
f = 1,3 – 13 kHz
In order to know where along the beam the blood flow data is colledted, a pulsed Doppler
must be used.The flow velocity is obtained from the spectral estimation of the received Doppler
signalThe ultrasound Doppler device can be either a continuous wave or a pulsed Doppler
A Continuous Wave
No minimum range
Simpler hardware
Range ambiguity
Low flow cannot be detected
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A Pulsed Doppler
Accuracy
No minimum flow
Minimum range
(Maximum flow) x (range)= limited the power decays exponentially because of the heating
of the tissue. The absorption coefficient ~ proportional to frequency the far field operation should
be avoided due to beam divergence.
Dnf = D2/ 4
D = Transducer diameter (e.g. 1 – 5 mm) the backscattered power is

proportional to f .The resolution and SNR are related to the pulse duration. Improving
either one of the parameters always affects inversely to the other
2.9.3 LASER DOPPLER FLOWMETRY
The principle of measurement is the same as with ultrasound

Doppler.The laser parameter may have the following properties:5 mWHe-Ne-laser
632,8 nm wavelength.
Figure 2.16 Laser Doppler flowmeter
The moving red blood cells cause Doppler frequency 30 – 12 000 Hz.The
method is used for capillary (microvascular) blood flow measurements
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Indicator Dilution Methods
Dye Dilution Method
A bolus of indicator, a colored dye (indocyanine green), is rapidly injected in to

the vessel. The concentration is measured in the downstream The blood is drawn
through a colorimetric cuvette and the concentration is measured using the principle of
absorption photometry
Figure 2.17 Dye Dilution Method
Thermal Dilution Method
A bolus of chilled saline solution is injected into the blood circulation system (right
atrium). This causes decrease in the pulmonary artery temperature. An artery puncture
is not needed in this technique.Several measurements can be done in relatively short
time .A standard technique for measuring cardiac output in critically ill patients
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Photoelectric Method
A beam of IR-light is directed to the part of the tissue which is to be measured for blood
flow (e.g. a finger or ear lobe)
Figure 2.18 Photoelectric Method
The blood flow modulates the attenuated / reflected light which is recorded.The light that
is transmitted / reflected is collected with a photodetector
Radioisotopes
A rapidly diffusing, inert radioisotope of lipid-soluble gas ( Xe or Kr) is injected into

the tissue or passively diffused
Figure 2.19 Radioisotopes
The elimination of the radioisotope from microcirculatory bed is related to the blood flow:
Thermal Convection Probe
 This is one of the earliest techniques for blood flow measurements

 The rate of heat removal from the tissue under probe is measured
 The concentric rings are isolated thermally & electrically from each other
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The central disk is heated 1 – 2 C over the temperature of tissue.A temperature difference of
2- 3 C is established between the disks.The method is not very common due extreme nonlinear
properties and difficulties in practical use (e.g. variable thermal characteristics of skin)
Figure 2.20 Thermal Convection Probe
2.10 CARDIAC OUTPUT
Definition: Volume of blood pumped by the heart per min

CO = SV x HR
Norm ~ 5 l/min
Cardiac index – corrected for body surface area
Affected by :
Met. Rate – pregnancy, hyperthyroid, septic
Preload / contractility / afterload
Clinical indicators of CO imprecise
Affected by anaesthetic agents used in everyday practice
Provides estimate of:
 whole body perfusion
 oxygen delivery
 left ventricular function
Persistently low CO associated with poor outcome
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Methods: Fick method

Dilution techniques – dye / thermal / lithium
Pulse contour analysis- LiDCO & PiCCO
Oesophageal doppler
TOE
Transthoracic impedance plethysmography
Inert gas through flow
Non-invasive cardiac output measurement
Fick Principle: Measure volume displacement 1st proposed 1870 ―the total uptake or release
of a substance by an organ is the product of the blood flow through that organ and the
arteriovenous concentration difference of the substance. Limited by cumbersome equipment,
sampling errors need for invasive monitoring and steady-state haemodynamic and metabolic
conditions
Indicator dilution techniques
An indicator mixed into a unit volume of constantly flowing blood can be used to
identify that volume of blood in time, provided the indicator remains in the system
between injection and measurement and mixes completely in the blood.
Dye dilution
 Inert dye – indocyanin green

 Injected into pulmonary artery and arterial conc. measured
using a calibrated cuvette densitometer
 Plot indicator dilution curve (see diagram) CO derived from area under
curve.
Indicator Dilution Curve
Figure 2.21 Indicator dilution curve
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Cardiac Output Measurement
Figure 2.22 Cardiac output measurement
2.11 RESPIRATORY RATE MEASUREMENT
Respiratory system provides a means of acquiring oxygen and eliminating CO 2. Various

laws are involved in the understanding of respiratory functions.
Various Gas laws are given below:
1. BOYLE’S LAW: It states that at constant temperature, the volume of gas varies
inversely with the pressure.
V2/V1 =P1/P2 here temperature T= constant
V2= Final volume
V1 = Initial volume
P1 = Original (initial) pressure
P2 = Final pressure
2. CHARLE’S LAW: It states that, at constant pressure, the volume of gas isdirectly
proportional to the absolute temperature.
V2/V1 =T2/T1 Here pressure P=constant
V2, V1 =Final, initial volume
T1 =original temperature
T2 = Final temperature
3 . HENRY’S LAW : It states that, if the temperature is constant, the quantity of a gas that
goes into a solution is directly proportional to the partial pressure of that gas . The gas with the
greater partial pressure will have more mass in solution.
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4. DALTON’S LAW : It states that, the total pressure exerted by a mixture of gases is equal to
the sum of the partial pressures of various gases.
PT =P1 + P2 + …………… +Pn
PT = total pressure
P1, P2 ,P3 = partial pressure of various gases
TYPES OF RESPIRATION
Types of respiration
Internal respiration External respiration
Respiration is nothing but the interchange of gases between an organism and the living medium
Internal respiration is the exchange of gases between the blood stream and nearby cells
.External respiration is the exchange of gases between the lungs and blood stream .
Lungs Volumes and Capacities (Respiration Parameters) Or (LVC)
Respiration parameters are used to indicate the state of respiratory function , including lung
volumes and capacities , airway resistance , lung compliance , etc .
Dead Air
Only a portion of the air entering the respiratory system actually reaches the alveoli . The
volume of air that is not available for gas exchange with the blood is known as dead air . The
total dead space is less less than 30 percentage of the total volume .
Tidal Volume (TV)
Tidal volume is the depth of breathing or the volume of gas inspired or expired during each
respiratory cycle. It is equal to 500 ml for a normal person .
Inspiratory Reserve Volume (IRV)
It is the maximal amount of gas that can be inspired from the end- inspiratory position (
Extra inspiration from the high peak tidal volume . It is equal to 3600 ml for a normal person
Expiratory reserve volume (ERV)
It is the maximal amount of gas that can be end expiratory level. It is equal to 1200 ml.
Residual Volume(RV)
It is the amount of gas remaining in the lungs at the end of maximal expiration. It is equal
to 1200 ml.
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Minute Volume (MV)

It is the volume of air breathed normally for 1 minute.
Total Lung Capacity(TLC)
It is the amount of gas contained in the lungs at the end of maximal inspiration and it is
the sum of inspiratory capacity(IC) and functional residual capacity (FRC). TLC is of 6000 ml
for a normal person.
Vital Capacity(VC)
It is the maximum amount of gas that can be expelled from the lungs by forceful effort
from maximal inspiration. It is 4800 ml for a normal person.
Inspiratory Capacity(IC)
It is the maximum amount of gas that can be inspired from the resting expiratory level and
it is the sum of tidal volume and inspiratory reserve volume. It is equal to 3600 ml for a normal
person.
Functional Residual Capacity(FRC)
It is the amount of gas remaining in the lungs at the resting expiratory level.
FRC = ERV + RV
Airway resistance
It relates to the ease with air flows through tubular respiratory structures. In smaller tubes,
airway resistance is high.
Lung Compliance
It is the ability of the alveoli and lung tissue to expand on inspiration.
Lung Elasticity
It is the ability of the lung’s elastic tissues to recoil during expiration
Intra thoractic Pressure
It is the positive and negative pressure occur within the thoracic cavity
Types of respiration rate measurement
1. Displacement method
2. Thermistor method
3. Impedance pneumography
4. CO2 method
5. Apnoea detectors
Displacement Method
In this method the transducer is hold by an elastic band which goes around the chest.The
respiratory movements results in a corresponding resistance changes of the strain gauge. It is
connected as one arm of a wheatstone bridge circuit. Its output varies with chest expansion. This
output corresponds to the respiration activity.
Thermistor Method
Generally there is a temperature difference between inspired and expired air. This temperature is
sensed by placing thermistor in front of nostrils. Thermistor is placed by using suitable stand. The
thermistor is connected with the bridge circuit. So unbalance signal is amplified to get the
respiratory activity.
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2.11. 1 IMPEDANCE PNEUMOGRAPHY
This is the indirect method of measurement . impedance pneumography is based on the fact
that , the a.c impedance across the chest of a patient changes as respiration occurs . 50-50KHz a.c
signal is produced by oscillator circuit and is given to the chest of the patient through electrodes
.The signal voltage applied to the amplifier (Differential amplifier) block is the voltage drop
across the resistance .
50 to 500
kHz
oscillator
patient
Amplifier Demodulator recorder
Figure 2.23 Impedance pneumography
V = I(R+ R)
Where V= Output voltage (V)
I= Current through the chest (A)
R= chest impedance without respiration (R)
R= change of chest impedance due to respiration (Q)
The output of the amplifier is given to demodulator and filter block. Hence low pass filter is used
to remove the residual carrier signal. The output of the impedance pneumograph contains
respirating rate data.
CO2 Method
Respiration rate can be measured by measuring CO2 in expired air. This CO2 method of
measurement is based on the absorption property of infrared rays by certain gases .When infrared
rays are passed through the expired air which contains certain amount of CO2, some of radiations
are absorbed by it. So, there is loss of heat energy associated with the rays .The detector changes
the loss in heating effect of the rays into an electrical signal. It is used to get the average
respiration rate. Two infrared sources are available in this set up. The beam from one infrared
source falls on the test cuvette side. The beam from another infrared source falls on the reference
cuvette side.
The detector has two identical portions. These portions are separated by a thin, flexible
metal diaphragm. The detector is filled with a sample of pure CO 2. Because of the absorption of
CO2 in the test cuvette. The beam falling on the test side of the detector is weaker that falling on
the reference side. The gas in reference side is heated more than that on the test side. So
diaphragm is pushed slightly to the test side of the detector. This diaphragm forms one plate f a
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capacitor. The a.c signal appears across the detector is amplified and recorded using recorder.
The amplified output is integrated. It is used for continuous monitoring the respiration rate.
Apnoea Detectors
Apnoea is the stopping of breathing. It leads to the arrest of the circulation. It can be
occurred at the conditions like head injury, drug overdose, etc. It can also occur in premature
babies during the first week of life because of their immature nervous system. If apnoea persists
for a prolonged period, then brain functions can be severly damaged. So apnoea patients are
closely monitored. Apnoea monitor is used to watch the apnoea patients respiration rate. Apnoea
monitor gives audio signals and visual signals, when no inspiration occurs for a particular period
of time. Input from the sensor is connected with the amplifier circuit having high input
impedance.
Negative Positive Comparator Lamp to show

detector detector circuit motion
Sensor Lamp to
signal from amplifier indicate
the patient respiration
LPF Schmitt Alarm

circuit circuit
Apnoea period
selector circuit
Figure 2.24 Block diagram of apnoea monitor

The output of the amplifier circuit is connected with motion and respiration channel
blocks. Motion channel block differentiates motion and the respiration based on the frequency.
The frequency below 1.5 Hz is identified as respiration. The frequency above 1.5 Hz is identified
as motion. High frequency signal above the threshold is sensed by positive detector.
The frequency below the threshold is sensed by negative detector. The output of the
motion channel is connected with comparator circuit. It compares the amplitude of motion and
respiration. Based on the output corresponding lamp will glow. In the respiration channel, low
pass filter is used to remove high frequency signal. If there is no respiration, then schmid trigger
circuit gives the output to switch on the alarm.
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Apnoea period selector circuits contain low frequency alarm oscillator and tone oscillator,
and audio amplifier. Apnoea period selector circuit drives the alarm circuit. The output of alarm
circuit is connected with the speaker. So, where there is no respiration for a period of 10 or 20
sec, then audio signal through the speaker and visual signal through the flash light is delivered.
2.12 BLOOD PRESSURE
One of the oldest physiological measurements.Observation of blood pressure allows

dynamic tracking of pathology and physiology affecting to the cardiovascular system, which has
profound effects to all other organs of the body
Figure 2.25 Observation of blood pressure
 Originates from the heart

 Commonly refers to arterial blood pressure
Value depends on 3 factors:
 cardiac output diameter of arteries the quantity of blood

 Values should be lower than 120 / 80 mmHg(systolic pressure (SP) / diastolic pressure
(DP))
 High value increases the risk of heart attack and strokes
 Low value increases the risk of lower oxygen perfusion e.g. in brains.
However, the ’normal values’ differ from person to another
Pulse Pressure(PP) = SP - DP
Mean pressure (MP)

Average pressure during one cardiac cycle driving force of the peripheral perfusion.
an estimate can be done by using an empirical formula:
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MP = DP+PP/3
SP and DP may vary significantly throughout the arterial system but MP is quite uniform (in
normal situations)
1. Non-Invasive
Palpatory Method(Riva-Rocci Method)
Auscultatory Method
Ultrasonic Method
Oscillometric Method
Tonometry
2. Invasive
Extravascular Sensor
Intravascular Sensor
General on System Parameters
2.12.1 INDIRECT METHODS IN BLOOD PRESSURE MEASUREMENTS
Indirect measurement = non-invasive measurement
Figure 2.26 Blood pressure measurements

Brachial artery is the most common measurement site
Close to heart
Convenient measurement
Other sites are e.g.:
forearm / radial artery wrist (tends to give much higher SP)
The most common indirect methods are auscultation and oscillometry an occlusive cuff is
placed on arm and inflated to P > SP. Then the cuff is deflated gradually and the measurement of
blood flow is done .
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The occlusive cuff should be of a correct size in order to transmit the pressure to the
artery evenly and thus to obtain accurate results .A short cuff requires special attention in
placement. Longercuff reduces this problem. The cuff should be placed at the heart level in order
to minimize the hydrostatic effects .
Figure 2.27 Sphygmomanometro
2.12.1.1 PALPATORY METHOD (RIVA-ROCCI METHOD)
When the cuff is deflated, there is a palpable pulse in the wrist. P = BP .Several
measurements should be done as the respiration and vasomotor waves modulate the blood
pressure levels
Figure 2.28 Palpatory Method
Advantages
The blood pressure can be measured in noisy environment too
Technique does not require much equipment
Disadvantages
Only the systolic pressure can be measured (not DP)
The technique does not give accurate results for infants and hypotensive patients
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2.12.1.2 AUSCULTATORY METHOD

Pulse waves that propagate through the brachial artery, generate Korotkoff sounds. There
are 5 distinct phases in the Korotkoff sounds, which define SP and DP The Korotkoff sounds are
ausculted with a stethoscope or microphone (automatic measurement
Figure 2.29 Auscultatory Method

The frequency range is 20-300 Hz and the accuracy is +/- 2mmHg (SP) and +/- 4mmHg (DP).
Also with this method, several measurements should be done.
Advantages
Auscultatory technique is simple and does not require much equipment
Disadvantages
Auscultatory tecnique cannot be used in noisy environment
The observations differ from observer to another
A mechanical error might be introduced into the system e.g. mercury leakage, air leakage,
obstruction in the cuff etc.
The observations do not always correspond with intra-arterial pressure
The technique does not give accurate results for infants and hypotensive patients
2.12.1.3 ULTRASONIC METHOD
A transcutaneous (through the skin) Doppler sensor is applied here. The motion of blood-
vessel walls in various states of occlusion is measured. The vessel opens and closes with each
heartbeat when DP < P < SP .
The frequency difference between transmitted (8 MHz) and received signal is 40-500 Hz
and it is proportional to velocities of the wall motion and the blood. As the cuff pressure is
increased, the time between opening and closing decreases until they coincide.
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Figure 2.30 Ultrasonic Method
Advantages & Disadvantages

Can be also used in noisy environment
Can be used with infants and hypotensive individuals
Subject’s movements change the path from sensor to vessel
2.12.1.4 OSCILLOMETRIC METHOD
The intra-arterial pulsation is transmitted via cuff to transducer (e.g. piezo-electric) .The
cuff pressure is deflated either linearly or stepwise.The arterial pressure oscillations (which can
be detected throughout the measurement i.e. when P > SP and P < DP) are superimposed on the
cuff pressure SP and DP are estimated from the amplitudes of the oscillation by using a
(proprietary) empirical algorithm.
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Figure 2.31 Oscillometric Method
Advantages
In the recent years, oscillometric methods have become popular for their simplicity of use
and reliability.
MP can be measured reliably even in the case of hypotension
Disadvantage
Many devices use fixed algorithms leading to large variance in blood pressures
2.12.1.5 TONOMETRY
Linear array of pressure sensors is pressed against a superficial artery, which is supported
from below by a bone (radial artery). A sensor array is used here, because at least one of the
pressure sensors must lay directly above the artery .When the blood vessel is partly collapsed, the
surrounding pressure equals the artery pressure
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Figure 2.32 Tonometry
The pressure is increased continuously and the measurements are made when the artery is
half collapsed. The hold-down pressure varies between individuals and therefore a ’calibration’
must be done
Advantages
Can be used for non-invasive, non-painful, continuous measurement
Disadvantages
Relatively high cost
The wrist movement and tendons result in measurement inaccuracies
2.12.2 DIRECT METHODS IN BLOOD PRESSURE MEASUREMENTS
Direct measurement = Invasive measurement
A vessel is punctured and a catheter (a flexible tube) is guided in The most common sites
are brachial and radial arteries but also other sites can be used e.g. femoral artery A division is
made into extravascular and intravascular sensor systems .This method is precise but it is also a
complex procedure involving many risks Used only when essential to determine the blood
pressure continuously and accurately in dynamic circumstances
2.12.2.1 EXTRAVASCULAR SENSOR

The sensor is located behind the catheter and the vascular pressure is transmitted via this
liquid-filled catheter.
The actual pressure sensor can be e.g. strain gage,variable inductance,variable capacitance
Optoelectronic,piezoelectric, etc…
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Figure 2.32 Extravascular Sensor

The hydraylic link is the major source of errors. The system’s natural frequency may be damped
and degraded due (e.g.):
too narrow catheter
too long tubing
various narrow connections
air bubbles in the catheter
Figure 2.33 Catheter sensor system
The catheter-sensor system must be flushed with saline-heparine solution every few minutes in
order to prevent blood from clotting at the tip.
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Normally the interesting frequency range is 0 – 100 Hz. If only MP is measured the
bandwidth is 20 Hz (harmonics > 10 are ignored)
2.12.2. 2 INTRAVASCULAR SENSOR

sensor is located in the tip of the catheter. This way the hydraulic connection is replaced
with an electrical or optical connection .The dispacement of the diaphragm is measured .The
frequency response is not limited by the hydraulic properties of the system.
No time delay.
Electrical safety and isolation when using fiber optics
Breaks easily
More expensive
Disposable Sensors
Disposable sensors decrease the risk of patient cross-contamination and reduce the
amount of handling by hospital personnel
Cheaper and more reliable than reusable pressure sensors
2.12.2.3 GENERAL ON SYSTEM PARAMETERS
Even minute air bubbles in catheter have a dramatic effect on frequency response
The natural frequency and the length of the catheter have a following relationship:
fn  1
L
The catheter diameter has a linear relationship to natural frequency Stiffer catheters have
a higher frequency response
2.13 TEMPERATURE MEASUREMENT:

Temperature is one of the inductor of the general well being. Two types of temperature
measurements can be obtained from the body. These are
 Systematic temperature
 Surface temperature
Systematic temperature is the temperature of the internal region of the body. Usually, the
heat is generated by the active tissues of the body and heat is lost by the body to the environment.
But, the temperature of the body is maintained carefully. The normal mouth temperature is 37 0C.
the normal underarm temperature is about 10C lower than the above temperature. Systemic
temperature is measured accurately at tympanic membrane of ear. The brain contains the
temperature control centre for the body.
Systemic body temperature measurement
Mercury thermometer is used to measure the systemic temperature. It is inexpensive to use..

when continuous temperature recording is necessary, then, thermocouple or thermistor can be
used. In thermocouple, a junction of two dissimilar metals produces an output voltage. This is
proportional to the temperature at that junction.
Thermistor is a temperature sensing device. Its resistance varies with the temperature. This is
mostly preferred in the biomedical field compared with thermocouple. Thermistor can be
manufactured in a various shapes. In this thermistor, the relationship between resistance change
and temperature is nonlinear. The resistance of the thermistor is given by using the expression,
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Rt = Rr eβ(1/T1 - 1/T0)
Rt =resistance at temperature Tt
Rr = resistance at temperature T0
T1 = temperature at which measurement is taken
T0 = reference temperature
Β = temperature cosfficient
Special circuits are used to overcome the nonlinear characteristics of thermistors. This
special circuit consists of 2 matched thermistors.
Problems associated with thermistor
Self heating is very important problem in thermistor. This problem can be overcome by
limiting the current used in measurement. The power dissipation of thermistor is to be
maintained in milliwatts range to overcome this problem.
Thermistor probe should be chosen correctly based on

 Resistance range
 Sensitivity
Skin temperature measurement
Skin temperature is not constant throughout the body. It is varied from 300C to 350C. Various
factors affect the skin temperature are given below
 How fat covers over capillary area
 How the skin portion is exposed to ambient temperature
 Blood circulation pattern beneath the skin
Probe used for measurement
A small flat thermistor probe is used to measure the skin temperature.
Infrared thermometer
It is a device used to measure skin surface temperature. It is used to locate breast cancer. It is
also used to identify the spots in which blood circulation is poor.
2.14 PULSE MEASUREMENT
When heart muscle contracts , blood is ejected from the ventricles and a pulse of pressure is
transmitted through the circulatory system. This pulse can be measured at various points. We can
sense the pulse by placing our finger tip over the radial artery in the wrist. This pulse travels at
the speed of 5 to 15m per second. Photoelectric method is commonly employed to measure the
pulse.
Types:
Photoelectric method consists of two types
 Tramsmittance method
 Reflectance method
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2.14.1 TRANSMITTANCE METHOD OF PULSE MEASUREMENT
LED and photoresistor are used in this method. These are mounted in a enclosure that fits
over the tip of the finger. Light is produced by the LED. The same light is passed through the
finger. For each heart pulse , blood is forced to the extremities and the amount of blood in the
finger is increased. So optical density is changed. So, the light transmitted through the finger is
decreased. This light is received by the photo resistor. This photo resistor is connecte with the
part of voltage divider circuit. The voltage produced by this circuit is directly proportional to the
amount of blood flow in the figure. The output ius recorded by using strip chart recorder.
2.14.2 Figuer 2.34 Transmittance Method Of Pulse Measurement
2.14. 2 REFLECTANCE METHOD
N reflectance method, LED is placed adjacent to the photoresistor. LED emits the light.
This light is reflected form the skin and the tissues falls on the photo resistor. The reflected light
varies depending upon the blood flow in the finger. The photo resistor is connected as a part of
the voltage divider circuit. The output obtained is directly proportional to the amount of blood in
the finger. The output can be recorder using strip chart recorder.
Figure 2.35 Reflectance Method

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2.15 BLOOD CELL COUNTER

• The blood cell counter count the number of RBC or WBC per unit of volume of blood
using either of two method:
– Electrical method called aperture impedance change
– Optical method called flow cytometry
Aperture impedance change

• When blood is diluted in the proper type of solution, the electrical resistivity of blood
cells (ρc) is higher then the resistivity of the surrounding fluid (ρf)
• By contriving a situation in which these resistivities can be differentiated from each other,
we can count cells
Blood cell sensing

• The sensor consist of a two-chamber vessel in which the dilute incoming blood is on one
side of barrier, and the waste blood to be discarded is on the other
• A hole with a small diameter (50μm) is placed in the partition between the tow halves of
the cell
• Ohmmeter measure the change on the resistance when the blood cell pass the aperture
Figure 2.36 Blood cell sensing
2.15.1 COULTER COUNTER

• Constant current source (CCS) and voltage amplifier replace the ohmmeter
• RA is the resistance of the aperture and will be either high or low, depending on whether
or not the blood cell is inside the aperture.
• Amplifier convert the current pulse to voltage pulse
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Figure 2.37 Block diagram of Coulter Counter
2.15.2 FLOW CYTOMETRY CELL COUNTERS
Optical flow cytometry sensing

• The optical cytometry sensor consists of a quartz sensing sheath designed with a
– hydrodynamic focusing region
– cell path region that passes only a single cell at time.
• Focusing is done by decreasing the diameter of the aperture.

• Light source is (He-Ne) Laser
• Two Photodetectors (photosensors)

– Photodetector A detects forward scatted light
– Photodetector B detects orthogonal scatted light
• blood sample enters the analyzer

– Optical counter → WBC count
– Colorimeter → hemoglobin
– Optical flow sensor → RBC count
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Figure 2.38 Optical flow cytometry
The blood is actually split into different chambers, where in each chamber it is diluted /
mixed to differentiate different cell types. WBC and RBC are separated (using lysing)
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UNIT III
3.1 CARDIAC PACEMAKERS
Definition:
A device capable of generating artificial pacing impulses and delivering them to

heart is known as pacemaker system or pacemaker.
 It consists of a pulse generator and electrodes. Sino Atrial node is responsible for
the starting of heart beat, hence it is called as Natural Pacemaker.
Types of pacemakers:
 Internal pacemaker
 External pacemaker
3.1.1 INTERNAL PACEMAKER
 It is placed inside the body. It may be permanently implanted on the patients

whose SA nodes are failed to function or those who suffered from permanent heart block.
 Internal pacemaker systems are implanted with the pulse generator placed in a
surgically developed pocket below the right or left clavicle, in left sub costal region.
 In case of women it is placed beneath the left or right major pectoral’s muscle.
 Internal leads are connected to the electrodes that directly contact the surface of
the myocardium.
 The exact location of the pulse generator used in the internal pacemaker system
depends on the following factors.
 Type and nature of the electrode used.
 Nature of the cardiac problems.
 Mode of operation of the pacemaker system.
 There is no external connection for applying power. So the pulse generator should
be completely self contained with a battery, which is capable of operating
continuously for a specified period.
3.1.2 EXTERNAL PACEMAKER
 It consists of an externally placed pulse generator circuit connected to the

electrodes placed on the myocardium.
 Temporary heart irregularities or disorders.
 Treating the patient from arrhythmias.
 Treatment of coronary patient and during the cardiac surgery.
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 It consists of pulse generators. They are placed m the body and connected
normally to the electrode with the help of wires introduced into the right ventricle.
 The pulse generator may be strapped to the lower arm of the patient.
TYPES OF PACING MODES
PACING MODES
Competiti ve mode Non - Competitive mode
Asynchronous mode (fixed rate) ventricular programmed Atrial programmed
Demand mode Standby mode Synchronous mode
(R –wave inhibited) (R –wave triggered) (P-wave)
VENTRICULAR ASYNCHRONOUS PACEMAKER (FIXED RATE PACEMAKER)
 It can be implemented in atrium or ventricle.

 Suitable for patients who are suffered by total AV block, atrial arrhythmia.
 It consists of square wave generator and monostable multivibrator circuit. The
period square
Wave generator is given as T.
 T=-2(RC) ln
T can be modified by changing the R,C,R2,R3 values.
Pulse duration is given by
Td = 5Cc
Disadvantages:
 Heart beat rate cannot be changed.

 If it is fixed in atrium, atrium beat at a fixed rate. If ventricle beat at a different
rate, and then it leads to a severe problem. Ventricular fibrillation may be
occurred.
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VENTRICULAR SYNCHRONOUS PACEMAKER (STANDBY PACEMAKER)
 Suitable for the patients who are suffered by short period of AV block.
 Electrode placed in the right ventricle of heart. This electrode is used to sense the
R-wave.
 If ventricular contractions are absent, then the pacemaker provides the impulses.
This type of pacemaker does not compete with the normal heart activity.
Refractory Fixed rate Output

Amplifier Filter period control & pacemaker amplifier
timing circuit
Figure 3.1 Ventricular synchronous pacemaker
 Electrode is used to detect the heart rate and it is given to the amplifier and filter
circuit. Because heart rate amplitude is very low. Amplifier is used to amplify the
cardiac signal. Filter is used to remove unwanted noise signal.
 Signal is given to refractory period control and timing circuit.
 R-wave is below the certain level, at that time only, this pacemaker will deliver
the pulses.
Advantages:
 Ventricular fibrillation is avoided.

 When R-wave is normal , then fixed rate pacemaker block is not in ON condition,
so power consumption is reduced.
Disadvantages:
 Very sensitive to electromagnetic interferences.

 No synchronization between atrial and ventricular contraction.
VENTRICULAR INHIBITED PACEMAKER (DEMAND PACEMAKER)
 Comparator determines the pacing rate of the pulse generator.

 Output is given to second RC network.The pulse width circuit determines the
duration of the stimulating pulses.
 Rate limiting circuit disables the comparator for a short interval and limits the
pacing rate.
 Output circuit provides a voltage pulse to stimulate the heart.
 Voltage monitor circuit senses the cell depletion and controls the rate slow down
circuit and energy compensation circuit.
 Rate slow down circuit shuts off some current to the basic timing to slow down
pulse rate during cell depletion.
 Energy compensation circuit causes the pulse duration unit to increase the battery
voltage, when it decreases and it is used to supply the energy to heart.
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 Sensing circuit detects a spontaneous R-wave and resets the oscillator timing
capacitor.
 Reversion circuit helps the amplifier to detect spontaneous R wave in the presence
of low level continuous wave interference.
Refractory Sensing Reversion

circuit circuit circuit
Output Rate limit Pulse width

Timing
circuit circuit circuit
circuit
Energy
compensati Rate slow
on circuit down circuit
Voltage
monitor
Figure 3.2 Ventricular inhibited pacemaker

 In the absence of R wave the circuit allows the oscillator to produce pacing pulses
at its present rate.
 The inhibited pacemaker allows the heart to pace at its normal rhythm when it is
able to do.
 If the R wave is missing for a preset period of time, then the pacemaker will turn
ON and provide the heart a stimulus. Hence it is termed as Demand pacemaker.
ATRIAL SYNCHRONOUS PACEMAKER
 P wave is sensed and picked by the electrode fixed on the atrium. It is given to the
amplifier circuit.
 Amplifier circuit is used to amplify the P-waveform.
 Circuit is used to give the delay 0.12 second.
Refractoryc
Amplifier Delay ontrol & Output
circuit presetted amplifier
Atrium multivibrato To ventricle

r
Figure 3.3 Atrial Synchronous Pacemaker
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 The output of the delay circuit given to refractory control and preset multivibrator
block.
 If the P wave amplitude is not in normal value, then fixed rate pacemaker will turn
ON. When P-wave amplitude is normal, then fixed rate pacemaker is OFF.
 If fixed rate pacemaker is ON, then the output is given to amplifier. The amplified
signal is given to ventricle through electrode.
 Refractory control circuit provide some time delay, because pacemaker pulse is
too large.
ATRIAL SEQUENTIAL VENTRICULAR INHIBITED PACEMAKER
 It is used to stimulate both atrial and ventricles. It is a demand pacemaker, so

based on the patients need, it provides the impulses.
 In the modern pacemakers, magnet is placed over the pacemaker on the skin of the
patient. This magnet is used to activate the reed switch. This switch, switches the
pacemaker into any one of the mode of operation, either to give the impulse for
atrial or to ventricle.
COMPONENTS OF PACEMAKER
 Pulse generator
 Electrodes
 Battery
METHODS OF STIMULATION OF PACEMAKER
 External stimulation- Used to restart the normal rhythm of the heart in case of
cardiac standstill.
 Internal stimulation-It prevents normal self triggering of the heart.
3.2 DC DEFIBRILLATION
INTRODUCTION
 To overcome the disadvantage of defibrillation method In 1962,Bernard lawn

from Harward school of public health and peter bent of Brigham hospital developed a
new method known as dc defibrillation.
 In this dc defibrillation method , a capacitors charged to a high dc voltage and then
rapidly discharged through electrodes across the chest of patient.
 DC defibrillation is capable of correcting both the atrial fibrillation and ventricular
fibrillation.
 DC method produces some harm to the patient. Depending on the energy setting in
the defibrillator , the amount of electrical energy discharged by the capacitor ranges
between 100 to 400 joules. Discharge portion is approximately 5 ms.
 In discharge waveform ,the peak value ofs current is nearly20 A and the wave is
monophasic in nature.
 Monophasic means most of the excursion of curve is above the base line.
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Figure 3.4 DC defibrillator circuit
Energy level of a defibrillator can be controlling:The voltage amplitudeVPof the defibrillator by

varying the setting onthe varactor or Duration of the defibrillator pulse. The energy (WA) stored
in the capacitor C and available for the defibrillation is:
Lown waveform: Curve 1 shows a typical discharge pulse of defibrillator which called
―Lown waveform.
I rises rapidly to app. 20 A
Then I decays to 0 with 5 ms
A negative pulse is produced for 1 to 2 ms
The pulse width defined as the time that elapses between the start of the
impulse and the moment that the current intensity passes the zero line for the first time
and changes direction (5 ms or 2.5 ms)
Figure 3.5DC defibrillator waveform

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DUAL PEAK DC DEFIBRILLATOR
If peak voltage is as high as 6000V is used there is a possibility of damaging myocardium

and the chest walls.
 Produce dual peak wavereform of longer duraoltation at lower voltage.

 Effective defibrillation is achieved in adults with lower level of delivered energy.
 Energy range is between 50 to 200W-sec or joules.
 Effective defibrillation at the desirable lower voltage levels is also possible with
the truncated waveform.
 The amplitude of the waveform is relatively constant, but is varied to get required
energy.
 Large electrodes are used for the proper delivery of large current through the
surface of the skin.
 These electrodes are called as paddles .
EXTERNAL DEFIBRILLATOR:
 A unit based on computer technology and designed to analyze the heart

rhythm itself, and then advise whether a shock is required.
 It is designed to be used by lay persons, who require little training.

 It is usually limited in their interventions to delivering high joule shocks for VF
and VT rhythms
 The automatic units also take time (generally 10-20 seconds) to diagnose the
rhythm, where a professional could diagnose and treat the condition far quicker
with a manual unit.
 Automated external defibrillators are generally either held by trained personnel

who will attend incidents, or are public access units which can be found in places
including corporate and government offices, shopping centers, airports,
restaurants,
 AEDS require self-adhesive electrodes instead of hand-held paddles for the two
following reasons:
 The ECG signal acquired from self-adhesive electrodes usually contains less
noise and has higherquality ⇒ allows faster and more accurate analysis of the
ECG ⇒ better shock decisions. Hands off‖ defibrillation is a safer procedure for
the operator, especially if the operator has little or no training.
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Figure 3.6 External Defibrillator
DC DEFIBRILLATOR WITH SYNCHRONIZER
 Synchronization means, synchronized the working of the heart with the

pacemaker. Synchronized DC defibrillator allows the electric shock at the right
point on the ECG of the patient.
 Electric shock is delivered approximately 20 to 30 ms after the peak of R wave of
patients ECG.
ECG Time delay Defibrillator

Patient
amplifier circuit circuit
To chest
of patient
Figure 3.7 Block diagram of DC Defibrillator With Synchronizer
Working
 ECG waveform is traced from the patient.

 R-wave in the output of ECG amplifier triggers the time delay circuit .It gives the
delay of
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30 ms approximately. After that, defibrillator circuit is switched ON. So that, the

capacitor discharges the electric shock to the patient’s heart.
 The moment at which electric shock occurs is noted by producing the marker
pulse on monitoring display.
 This type of circuit is preferred in cardiac emergencies
 The sudden cardiac arrest can be treated using a defibrillator and 80 percent of the
patients will be cured from the cardiac arrest if the is given within one minute of the
attack.
Electrodes used for defibrillation
 These paddles have metal disks of 8 to 10 cm in diameter for external use.

 For internal use smaller paddles are used on infants and children.
 For external use, pair of electrodes are firmly pressed against the patients chest.
Need of Insulation Handle
 To prevent the person applying the electrodes from accidential electric shock
specially insulated handles are provided in the paddles.
 When paddles are properly positioned , this prevents the patient from receiving a
shock.
 In earlier equipment a foot switch is used instead of thumb switch.
Need of Thumb Switch
 There is a possibility of someone accidentally stepping on the foot switch in the

excitement of an emergency before the paddles are placed. So thumb switches are
mostly preferred.
Charging of Defibrillators
 In some defibrillators charging is done by means of a charge switch located in the

front panel of the unit.
 The charge switch is located in the handle of one of its paddles.
 In few defibrillators the charging process begins automatically after discharge.
Types of Electrodes
Two electrodes are

 Anterior-anterior
 Anterior-posterior
 Anterior-anterior paddles are applied to the chest. Anterior-posterior paddles are

applied to both the patients chest wall and back so that energy is delivered through
the heart.
 Specially designed pediatric paddles are available with diameter ranging from 2 to
6 cm.
 Internal paddles can be either gas-sterilized or autoclaved.
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Indication Meter
 Most of the defibrillators include a watt second meter to inducate the amount of
energy stored in the capacitor before discharge.
 The energy indicated on the meter is lost or dissipated as heat in the components
inside the unit.
3.3 BIO TELEMETRY
Telemetry is a technology that allows remote measurement and reporting of

information. The word is derived from Greek roots tele = remote, and metron =
measure. Systems that need external instructions and data to operate require the
counterpart of telemetry, telecommand.
Although the term commonly refers to wireless data transfer mechanisms (e.g.
using radio or infrared systems), it also encompasses data transferred over other media,
such as a telephone or computer network, optical link or other wired communications.
Many modern telemetry systems take advantage of the low cost and ubiquity of GSM
networks by using SMS to receive and transmit telemetry data.
 Bio telemetry is the measurement of biological parameters over long distance.

 For conveying biological information from a living organism and its environment
to a different location where this can be recorded.
 This involves radio frequency signal as a carrier for modulation, referred to as
radio telemetry.
ELEMENTS OF BIOTELEMETRY
Biological Transducer Amplifier & Transmissio Output unit

signal filter(conditi n channel
electrodes
eg.ECG,EEG oner)
Figure 3.8 Block diagram of bio telemetry system

ECG,EEG,EMG- Electrodes act as transducer
For measuring temperatures-Thermisto is used as transducer
For measuring blood pressure-strain gauge is used as transducer
For measuring stomach pH-glass electrode is used as transducer.
DESIGN OF BIO TELEMETRY
 Telemetry system should be selected to transmit the bio –electric Signal with
maximum fidelity and simplicity.
 The sysetem should not affect the living system by any interference.
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 Smaller in size light in weight.

 It should have more stability and reliability.
 The power consumption at the transmitter and receiver should be small.
 It should reject common mode interference rejection.
 Miniatured radio telemetry system should be used to reduce noise.
3.3.1 RADIO TELEMETRY SYSTEMS
 Single channel telemetry system

 Multi channel telemetry system
3.3.1.1 SINGLE CHANNEL TELEMETRY SYSTEM
 For a single channel telemetry system, a miniature battery operated radio

transmitter is connected to the electrodes of the patients.
 The transmitter broadcasts the biopotential to a remote place in which the receiver
detects the radio signal and recovers signal for further processing.
 The receiving system can be located in a room separately from the patients.
 The only risk is shock to the patient.
Figure 3.9 Block diagram of Single Channel Telemetry System
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 Biosignal from the patient is converted into electrical signals by the transducer.
 They are amplified and filtered at the conditioner. Further they are frequency
modulated or pulse modulated.Frequency modulation provides the high noise
interference rejection and high stability.
 The biosignals are amplified to radio frequency range of few hundred KHz to
about 300 KHz and then they are transmitted by transmitter antenna.s
 At radio receiver the corresponding frequency are received and then they are
demodulated, amplified and displayed.
Transmission of bioelectric variables:
 Active measurements
 Passive measurements
Tunnel diode FM transmitter
 The tunnel diodes exhibit a specific characteristics known as negative resistance.
They have extremely low values of inductance an capacitance.
 It is used for the transmission of EMG,ECG, respiration rates.
 Tunnel diodes are used as active devices and this circuit has higher fidelity and
sensitivity.
 Total weight is 1.44 gm with battery and the size is small.
 Varactor diode is basically a reverse biased PN junction which utilizes the
inherent capacitance of depletion layer.
 Varactor diodes are voltage capacitors used for frequency modulation.
 The signal is transmitted through the inductor L of the tank circuit of RF
oscillator.
Advantages:
 All the signal can be transmitted by using the circuit.

 No shielded room is needed.
 Interference is much reduced.
Radio telemetry with sub carrier sytem:
Transmitter side:
 When the position of transmitter to the body or other conduction object change, the carrier
frequency and amplitude will change due to the loading change of the carrier frequency
resonant circuit.
 If the signal has a frequency different from the loading effect ,they can be separated by
filters. .Otherwise the real signal will be distorted by loading effect.
 To avoid this loading effect the sub carrier system is needed. The signal is modulated on
a sub carrier to convert the signal frequency to the neighbourhood of the sub carrier
frequency.
 Then the RF carrier is modulated by this sub carrier carrying the signal.
 The 20 KHz sub carrier signal is given to amplitude modulator.
 The signals are amplified and forwarded to the transmitter.
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Figure 3.10 Bio telemetry using sub carrier system
Receiver side:
 At the receiver end the receiver detects the RF and recovers the sub carrier carrying the
signal.
 At the receiver side, the signals are passed to demodulator, demodulated signal is filtered,
amplified by amplifier and then they are given to additional demodulator. It is used to
convert the signal from the modulated sub carrier system an to get the original signal.
 Finally the signal is displayed.
3.3.1.2 MULTI CHANNEL TELEMETRY SYSTEM:
 For most biomedical applications, simultaneous recording of Bio signals are required for
correlation study.
 Each signal is in need of one channel. When the number of channels is more than the two
or three, the simultaneous operation of the several single channel is difficult. At that time
multiple channel telemetry system is adopted.
Two types of multiplexing:
I) FDM
II) TDM
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Frequency division multiplex system
i/p Subcarrier
Amplifier FM
FM
transmitter
Amplifier Subcarrier
FM
Amplifier Subcarrier
FM
FM receiver
Subcarrier demod
output demodulator
LPF BPF
Subcarrier
LPF demodulator BPF
LPF Subcarrier BPF

demodulator
Figure 3.11 Frequency Division Multiplex System
 Each signal is frequency modulated on a sub carrier frequency.

 Modulated sub carrier frequencies are combined to modulate the RF carrier.
 At receiver the modulated sub carrier can be separated by the proper band pass filter.
 Then the each signals are demodulated by using specified frequency.
 Frequency of the sub carrier has to be carefully selected to avoid interference.
 The low pass filter are used to extract the signals without any noise. Finally the output
unit displays the original signal.
Time division multiplex telemetry system:
 Most biomedical signals have low frequency bandwidth requirement, we can use time
division multiple system by time sharing scheme.
 Transmission channel is connected to each signal channel input for a short time to sample
and transmit that signal.
 Transmitter is switched to the next input signal channel in a definite sequence.
 All the channels have been scanned once, a cycle is completed and the next cycle will
start. Scanning follows a order from signal 1 to signal 3.
 At the receiver the process is reversed. The sequentially arranged, signal pulses are given
to the individual channels by using gate signal generator.
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 If the number of scanning cycles per second is large and if the transmitter and the receiver
are synchronized, the signal in each channel at the receiver side can be recovered. But the
scanning frequency has to satisfy the following condition.
fscan = 2fmax
The maximum number of channels practically allowed is smaller than the calculated value of n to
avoid the interference between channels.
FM
Amplifier gate FM receiver gate LPF
transmi
Amplifier gate tter gate LPF
Amplifier gate Gate signal generator

gate LPF
Gate signal
generator
Figure 3.12 Time Division Multiplex System
Advantages of biotelemetry:
 Used to record the biosignals over long periods.

 Patient is not disturbed during recording
 For future reference or to study the treatment effect
 Monitor the athletes running a race.
 For monitoring the persons who are in action the biotelemetry is an ideal one.
 For recording on animals, particularly for research , the biotelemetry is greatly used.
Applications
Motorracing
 Telemetry is a key factor in modern motor racing, allowing race engineers to

interpret the vast amount of data collected during a test or race, and use that to
properly tune the car for optimum performance. Systems used in some series,
namely Formula One, have become advanced to the point where the potential
lap time of the car can be calculated and this is what the driver is expected to
meet. Some examples of useful measurements on a race car include
accelerations (G forces) in 3 axis, temperature readings, wheel speed, and the
displacement of the suspension. In Formula 1, the driver inputs are also
recorded so that the team can assess driver performance and, in the case of an
accident, the FIA can determine or rule out driver error as a possible cause.
 Later developments saw two way telemetry, that allowed the engineers the
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ability to update calibrations on the car in real time, possibly while it is out on
the track. In Formula 1, two-way telemetry surfaced in the early nineties from
TAG electronics, and consisted of a message display on the dashboard which
the team could update. Its development continued until May 2001, at which
point it was first allowed on the cars. By
 2002 the teams were able to change engine mapping and deactivate particular
engine sensors from the pits while the car was on track. For the 2003 season,
the FIA banned two-way telemetry from Formula 1, however the
technology still exists and could eventually find its way into other forms of
racing or road cars.
 In addition to that telemetry has also been applied to the use of Yacht racing.
The technology was applied to the Oracle's USA-76.
Agriculture
 Most activities related to healthy crops and good yields depend on timely
availability of weather and soil data. Therefore, wireless weather stations play a
major role in disease prevention and precision irrigation. These stations
transmit major parameters needed for good decisions to a base station: air
temperature and relative humidity, precipitation and leaf wetness (for disease
prediction models), solar radiation and wind speed (to calculate
evapotranspiration), water deficit stress (WDS) leaf sensors and soil moisture,
crucial to understand the progress of water into soil and roots for irrigation
decisions.
 Because local micro-climates can vary significantly, such data needs to come
from right within the crop. Monitoring stations usually transmit data back by
terrestrial radio though occasionally satellite systems are used. Solar power is
often employed to make the station independent from local infrastructure.
Water Management
 Telemetry has become indispensable for water management applications,

including water quality and stream gauging functions. Major applications
include AMR (automatic meter reading), groundwater monitoring, leak
detection in distribution pipelines and equipment surveillance. Having data
available in almost real time allows quick reactions to occurrences in the field.
Defense, space and resource exploration systems
 Telemetry is an enabling technology for large complex systems such as

missiles, RPVs, spacecraft, oil rigs and chemical plants because it allows
automatic monitoring, alerting, and record-keeping necessary for safe,
efficient operations. Space agencies asNASA, ESA, and other
agencies use telemetry/telecommand systems to collect data from operating
spacecraft and satellites.
 Telemetry is vital in the development phase of missiles, satellites and aircraft
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because the system might be destroyed after/during the test. Engineers need
critical system parameters to analyze (and improve) the performance of the
system. Without telemetry, these data would often be unavailable
Rocketry
 In rocketry, telemetry equipment forms an integral part of the rocket range

assets used to monitor the progress of a rocket launch. Some special problems
are the extreme environment (temperature, accelerations, vibrations...), the
energy supply, the precise alignment of the antenna and (at long distances, e.g.
in spaceflight) the signal travel time.
Flight Test
 Flight test programs typically telemeter data collected from on-board flight test
instrumentation over a PCM/RF link.[4] This data is analyzed in real-time for
safety reasons and to provide feedback to the test pilot. Particular challenges
for telemetering this data includes fading, multipath propagation and the
Doppler effect. The bandwidth of the telemetry link is often insufficient to
transfer all the data acquired and therefore only a limited set is sent to the
ground for real-time processing while an on-board recorder ensures the full
dataset is available for post flight analysis.
Enemy Intelligence
 Telemetry was a vital source of intelligence for the US and UK when Soviet
missiles were tested. For this purpose, the US operated a listening post in Iran.
Eventually, the Russians discovered this kind of US intelligence gathering and
encrypted their telemetry signals of missile tests. Telemetry was a vital source
for the Soviets who would operate listening ships in Cardigan Bay to eavesdrop
on the UK missile tests carried out there.
ENERGY MONITORING
 In factories, buildings, and houses, energy consumption of systems such as

HVAC are monitored at multiple locations, together with the related
parameters (e.g. temperature) via wireless telemetry to one central location. The
information is collected and processed enabling intelligent decisions regarding
the most efficient use of energy to be implemented. Such systems also facilitate
predictive maintenance.
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3.4 RADIO PILLS:
Transducer Oscillator Transmitti Receiving

and ng aerial aerial
transmitter
Loud speaker
Receiver Demodulat Tape recorder

or
Pen writer
Figure 3.13 Block diagram of Radio Pills
It contains transducer sensitive to pH, temperature and pressure. It is used for telemetring
continuous informations about one or various variables from lumen of the gut. Temperature
sensitive pills are designed by the medical research council’s bioengineering lab.
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UNIT IV
4.1 IONISING RADIATION
In general, ionizing radiation is harmful and potentially lethal to living beings but can
have health benefits in radiation therapy for the treatment of cancer and thyrotoxicosis.
Most adverse health effects of radiation exposure may be grouped in two general categories:
 Deterministic effects (harmful tissue reactions) due in large part to the killing/
malfunction of cells following high doses; and
 Stochastic effects, i.e., cancer and heritable effects involving either cancer development in
exposed individuals owing to mutation of somatic cells or heritable disease in their
offspring owing to mutation of reproductive (germ) cells.
Its most common impact is the stochastic induction of cancer with a latent period of years
or decades after exposure. The mechanism by which this occurs is well understood, but
quantitative models predicting the level of risk remain controversial. The most widely accepted
model posits that the incidence of cancers due to ionizing radiation increases linearly with
effective radiation dose at a rate of 5.5% per sievert. If this linear model is correct, then natural
background radiation is the most hazardous source of radiation to general public health, followed
by medical imaging as a close second. Other stochastic effects of ionizing radiation are
teratogenesis, cognitive decline, and heart disease.
High radiation dose gives rise to Deterministic effects which reliably occur above a
threshold, and their severity increases with dose. Deterministic effects are not necessarily more or
less serious than stochastic effects; either can ultimately lead to a temporary nuisance or a
fatality. Examples are: radiation burns, and/or rapid fatality through acute radiation syndrome,
chronic radiation syndrome, and radiation-induced thyroiditis.
Beneficially, controlled doses are used for medical imaging and radiotherapy, and some
scientists suspect that low doses may have a mild hormetic effect that can improve health, but the
US National Academy of Sciences Biological Effects of Ionizing Radiation Committee "has
concluded that there is no compelling evidence to indicate a dose threshold below which the risk
of tumor induction is zero
When alpha particle emitting isotopes are ingested, they are far more dangerous than their
half-life or decay rate would suggest. This is due to the high relative biological effectiveness of
alpha radiation to cause biological damage after alpha-emitting radioisotopes enter living cells.
Ingested alpha emitter radioisotopes such as transuranics or actinides are an average of about 20
times more dangerous, and in some experiments up to 1000 times more dangerous than an
equivalent activity of beta emitting or gamma emitting radioisotopes.
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 Medical use of radiation based on the fact that that it can destroy cells (instrument
sterilisation, treatment of cancer)
 Medical use of radiation based on the fact that radiation is easy to detect
Types of ionizing radiation
Figure 4.1 Different types of Ionizing radiation
Alpha (α) radiation consists of a fast-moving helium-4 (4He) nucleus and is stopped by a
sheet of paper. Beta (β) radiation, consisting of electrons, is halted by an aluminium plate.
Gamma (γ) radiation, consisting of energetic photons, is eventually absorbed as it penetrates a
dense material. Neutron (n) radiation consists of free neutrons that are blocked using light
elements, like hydrogen, which slow and/or capture them. Not shown: galactic cosmic rays that
consist of energetic charged nuclei like protons, helium nuclei, and high-charged nuclei called
HZE ions.
Ionizing radiation is categorized by the nature of the particles or electromagnetic waves

creating the ionising effect. These have different ionization mechanisms, and may be grouped as
directly or indirectly ionizing.
Directly ionizing
Any charged massive particle can ionize atoms directly by fundamental interaction
through the Coulomb force if it carries sufficient kinetic energy. This includes atomic nuclei,
electrons, muons, charged pions, protons, and energetic charged nuclei stripped of their electrons,
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all of which must be moving at relativistic speeds to reach the required kinetic energy. The first
two to be recognized were given special names, which are used today: Helium nuclei at
relativistic speeds are called alpha particles, and electrons at relativistic speeds are called beta
particles. Natural cosmic rays are made up primarily of relativistic protons but also include
heavier atomic nuclei like helium ions and HZE ions and muons. Charged pions are very short-
lived and seen only in large amounts in particle accelerators.
Alpha particles
Alpha particles consist of two protons and two neutrons bound together into a particle
identical to a helium nucleus. They are generally produced in the process of alpha decay, but may
also be produced in other ways. Alpha particles are named after the first letter in the Greek
alphabet, α. The symbol for the alpha particle is α or α2+. Because they are identical to helium
nuclei, theyarealsosometimeswrittenasHe2+or 42He2+indicating a Helium ion with a +2 charge
(missing its two electrons). If the ion gains electrons from its environment, the alpha particle can
be written as a normal (electrically neutral) Helium atom 42He.
They are a highly ionizing form of particle radiation, and when resulting from radioactive
alpha decay have low penetration depth. They can be stopped by a few centimetres of air, or by
the skin. However, so-called long range alpha particles from ternary fission are three times as
energetic, and penetrate three times as far. The helium nuclei that form 10-12% of cosmic rays
are also usually of much higher energy than those produced by nuclear decay processes, and are
thus capable of being highly penetrating and able to traverse the human body and dense
shielding, depending on their energy.
Beta particles
Beta particles are high-energy, high-speed electrons or positrons emitted by certain types
of radioactive nuclei, such as potassium-40. The production of beta particles is termed beta
decay. They are designated by the Greek letter beta (β). There are two forms of beta decay, β−
and β+, which respectively give rise to the electron and the positron.
High-energy beta particles may produce X-rays known as bremsstrahlung ("braking

radiation") or secondary electrons (delta ray)as they pass through matter. Both of these can
subsequently ionize as an indirect ionization effect.
Bremsstrahlung is of concern when shielding beta emitters, because interaction of beta

particles with the shielding material produces Bremsstrahlung radiation. This effect is greater
with material of high atomic numbers, so material with low atomic numbers is used for beta
source shielding.
Positrons
The positron or ant electron is the antiparticle or the antimatter counterpart of the
electron. The positron has an electric charge of +1e, a spin of ½, and has the same mass as an
electron. When a low-energy positron collides with a low-energy electron, annihilation occurs,
resulting in the production of two or more gamma ray photons (see electron–positron
annihilation).
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Positrons may be generated by positron emission radioactive decay (through weak interactions),
or by pair production from a sufficiently energetic photon. Positrons are common artificial
sources of ionizing radiation in medical PET scans.As positrons are positively charged particles
they can also directly ionize an atom through Coulomb interactions.
Indirectly ionizing
Figure4.2 Indirect Ionization
Radiation interaction - gamma rays are represented by wavy lines, charged particles and
neutrons by straight lines. The small circles show where ionization occurs.Indirect ionizing
radiation is electrically neutral and therefore does not interact strongly with matter. The bulk of
the ionization effects are due to secondary ionizations.
3 main uses of ionising radiation in medicine:

• Treatment
• Diagnosis
• Sterilisation
Cancer
Cancers are growths of cells (cancerous tumours) which are out of control. As a result of
this, they do not perform their intended function.
Treatment of Cancer
Cancerous tumours can be treated using the following main methods:

• Chemotherapy (drugs).
• Radiation therapy (radiotherapy and brachytherapy).
Surgery.
Factors which affect the choice of treatment for cancer.
The choice of treatment depends on a number of factors including:
• The size of the tumour.
• The position of the tumour.
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The Aims of Radiation Therapy
The aim of radiation therapy is to cause damage to the cancerous cells whilst minimising
the risk to surrounding healthy tissue
The damage inflicted by radiation therapy causes the cancerous cells to stop reproducing
and thus the tumour shrinks. Unfortunately, healthy cells can also be damaged by the radiation.
The amount of radiation given to the patient has to be accurately calculated so that the damage is
limited to the cancerous cells only.
Radiation Therapy
Radiation therapy uses ionising radiation to treat cancer i.e. to destroy cancerous cells.
There are two techniques in radiation therapy that are used to treat cancer using ionising
radiation:
Diagnosis
Static Imaging
• There is a time delay between injecting the tracer and the build-up of radiation in the
organ. Static studies are performed on the brain, bone or lungs scans
Dynamic Imaging
• The amount of radioactive build-up is measured over time.
• Dynamic studies are performed on the kidneys and heart.
• Renograms are dynamic images of the kidneys and they are performed for the following
reasons:
• To assess individual kidney and/or bladder function.
• To detect urinary tract infections.
• To detect and assess obstructed kidney(s).
• To detect and assess vesico-ureteric reflux.
• To assess kidney transplant(s).
Sterilisation
• Radiation not only kills cells, it can also kill germs or bacteria.
• Nowadays, medical instruments (e.g. syringes) are prepacked and then irradiation using
an intense gamma ray source.
• This kills any germs or bacteria but does not damage the syringe, nor make it
radioactive.
5.2 DIAGNOSTIC X-RAY EQUIPMENTS
X- rays are electromagnetic waves X-rays are similar to light and sound waves.
But the frequency and wavelength are different.
 Electromagnetic waves follow the relationship

ν = fλ
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Where
ν = velocity
λ = wavelength
f = frequency
 Electromagnetic wave is propagated in straight line.

 Electromagnetic wave follows the inverse square law
Intensity α 1/ d2
Where d = distance covered by the electromagnetic wave

 Electromagnetic waves are not deflected by the magnetic fields.
 Electromagnetic waves produce interference
X Ray Radiations
X ray was invented by Roentgen in 1895.
Two types of X ray radiations are
 Bremstrahlung radiation
 Characteristic X ray radiation
X rays are produced from the two different types of radiation that are listed above.
BREMSTRAHLUNG RADIATION
1. When the fst moving electron enters into the orbit of anode material atom, its velocity is
continuously decreased due to scattering by the orbiting electrons. Thus the loss of
energy of that incident electrons will appear in the form of continuous X rays or white
rays.
2. This type of radiation is used in medical application based on the principle of energy
absorption.
CHARACTERISTIC X RAY RADIATION
1. It occurs when the incident electron ejects out of the K shell or L shell e - in the
anode material atom.Immediately the higher orbit e- will falls into the vacancy to
achieve equilibrium. During its transition, the extra energy is emitted in the form of
characteristic X ray photon.
X ray tube:
 X ray tube is similar to that of CRT except it employs rotating anode. The speed of
rotating anode varies from 3600 to 10000 rpm. Electrons are emitted from the cathode
and focused on rotating anode and X ray is produced. Only one percent of energy is
converted into X ray and 99% is converted into thermal or heat energy.
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 X ray machine has five different blocks

1. Power supply
2. X ray tube aluminium filter
3. Collimator
4. Bucky diaphragm
5. Lead shield
X ray output can be obtained when electrons heat the anode
Q= constant IB t VA2
IB = Beam current
T = exposure time
Q = X ray output
VA = Anode voltage in the order of 100 kV
Efficiency η = X ray beam energy/ Electron beam energy
= 1.4 x 10-9 Z VA
Density or darkness of the image is directly proportional to the amount of X rays that
penetrate the film
Contrast is measure of the darkness of desired image.
Contrast between two tissues = 10 log I1/I2 decibel
Power supply
 X ray will have high voltage source and high voltage transformer and high voltage
rectifier. The power supply arrangement will have the options for filament current
control, rotor control, timer control and thermal overload production circuit.
 The various component in the X ray machine are used to improve the the quality of
the image, increase the contrast, improve the resolution size and minimize the dose
of X rays used on the patient.
 The density or darkness of the image is proportional to the amount of X rays that
penetrate the film. Contrast is a measure of darkness of the desired image, compare
to its surroundings.
 The good contrast in image will mainly depends on the mass attenuation
coefficient.
Aluminum filters:
The emitted X rays wiil contain a broad range of frequency generally the aluminium
filters will observe the lower X ray frequency and hence the intensity of low frequency
X ray incident on the patient is reduced.
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Collimator:
Collimator is placed between the patient and aluminium filter. It is nothing but an
aperture .
Figure 4.3 Block diagram of X ray machine
diaphragm which restricts the X ray beam falling on the patient. The necessary shape of
X ray beam is obtained only by collimator. A lamp and reflecting mirror arrangement
will makes a visible attern on the patient, so that the medical attendant can tell where
the X ray will strike. And this arrangement is used to align or positioning the beam on
the patient.
Bucky grid
 It is used to reduce scattered radiation

 The bucky grid is placed between the patient and the film cassette to improve
the sharpness of image.
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Figure 4.4 Diagram of Bucky grid
Radiography
 X ray images developed by photography or photosensitive film

 High resolution in images can be obtained
 Wide range of contrast can be obtained
 Patient is not exposed to X rays during the examination of the X ray image
 The patient dose is very low
 Permanent record is available
 The image can be obtained after developing the film and examination can be
made before developing the film
 Movement of organs cannot be observed
 Efficient is more
Fluoroscopy
Fluoroscopy is the method that provides real-time X ray imaging that is especially useful
for guiding a variety of diagnostic and interventional procedures.
The ability of fluoroscopy to display motion is provided by a continuous series

of images produced at a maximum rate of 25-30 complete images per second. This is similar to
the way conventional television or video transmits images.
While the X ray exposure needed to produce one fluoroscopic image is low (compared
to radiography), high exposures to patients can result from the large series of images that are
encountered in fluoroscopic procedures. Therefore, the total fluoroscopic time is one of the
major factors that determines the exposure to the patient from fluoroscopy.
Figure 4.5 Fluoroscopy

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Because the X ray beam is usually moved over different areas of the body during a
procedure, there are two very different aspects that must be considered. One is the area most
exposed by the beam, which results in the highest absorbed dose to that specific part of the skin
and to specific organs.The other is the total radiation energy imparted to the patient’s
body, which is related to the Kerma Area Product (KAP or PAK), a quantity that is easily
measurable.
The absorbed dose to a specific part of the skin and other tissues is of concern in
fluoroscopy for two reasons: one is the need for minimizing the dose to sensitive organs, such as
the gonads and breast, by careful positioning of the X ray beam and using shielding when
appropriate.The second is the possible incidence of the radiation beam to an area of the skin
for a long time that can result in radiation injuries in cases of very high exposure.
On the other hand, the total radiation energy imparted to the patient’s body during a
procedure is closely related to the effective dose ) and to the risk of radiation induced cancer.
In fluoroscopy, as in all types of X ray imaging, the minimum exposure required to form
an image depends on the specific image information requirements.An important characteristic of
a fluoroscopic system is its sensitivity, i.e. the amount of exposure required to produce images.
The use of intensifier tubes and more modern digital flat panel receptors make it possible to
optimize the balance of patient exposure with image quality so as not to expose the patient to
unnecessary radiation.Non-intensified fluoroscopy with just a fluorescent screen for a receptor
should not be used because of the excessive exposure to the patient.
Applications of X ray
 X ray is used to visualize skeletal structure

 X ray is used to take chest radiograph
 Bronchography
 Heart examinations are performed by taking frontal and lateral X ray film
images
 Gastro intestinal tract can be imaged by using X ray
 Urinary tract can be examined by using X rays
Angiography
 Angiography is a special X ray imaging technique through which high contrasts

can be obtained.
 The outline of the blood vessels are visible in angiogram
 Angiocardiography: It mean study of heart
 Cerebral angiography: It mean study of brain
 Bronchography: It maen study of lungs
 Nephro angiography: it mean study of kidney
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4.3 USE OF RADIO ISOTOPE IN DIAGNOSIS
Nuclear medicine uses radiation to provide diagnostic information about the

functioning of a person's specific organs, or to treat them. Diagnostic procedures are now
routine.
 Radiotherapy can be used to treat some medical conditions, especially

cancer, using radiation to weaken or destroy particular targeted cells.
 Tens of millions of nuclear medicine procedures are performed each year, and
demand for radioisotopes is increasing rapidly.
Radiation is used to both detect and treat abnormalities in the body. We've already
discussed the use of iodine-131 therapy for hyperthyroidism. Iodine-131 can also be used
in a diagnostic procedure to monitor the function of the thyroid.
The rate at which the thyroid rakes up the iodine-131 can be monitored with a scanning
device to see if it is functioning properly.What makes radioisotopes so useful in diagnostic
procedures is that the body treats the tagged isotope in the same way that it treats the
nonradioactive element.
Therefore, the tagged isotope goes right to the area of the body where you want it to go.
For example, iodine, whether it's radioactive or not, goes right to the thyroid, where it is
incorporated into the amino acid thyroxine (the only molecule in the body that contains
iodine). Therefore, iodine-131 is perfect for monitoring the thyroid gland.
Chromium, in the form of sodium chromate, attaches strongly to the hemoglobin of

red blood cells. This makes radioactive chromium-151 an excellent isotope for determining
the flow of blood through the heart. This isotope is also useful for determining the lifetime of
red blood cells, which can be of great importance in the diagnoses of anemias.
Radioactive cobalt (cobalt-59 or cobalt-60) is used to study defects in vitamin B12

absorption. Cobalt is the metallic atom at the center of the B12 molecule. By injecting a patient
with vitamin B12, labeled with radioactive cobalt, the physician can study the path of the
vitamin through the body and discover any irregularities.
One method is teletherapy, in which a high-energy beam of radiation is aimed at the

cancerous tissues. A second method is brachytherapy, in which a radioactive isotope is placed
into the area to be treated. This is usually done by means of a seed, which could be a glass bead
containing the isotope. In this way the isotope delivers a constant beam of radiation to the
affected area.
The third method is called radiopharmaceutical therapy. This method involves oral or
intravenous administration of the isotope. The isotope then uses the normal body pathway to
seek its target. This is the method that is used to get iodine-131 to the thyroid gland.
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A synthetic radioisotope is a radionuclide that is not found in nature: no natural process

or mechanism exists which produces it, or it is so unstable that it decays away in a very short
period of time. Examples include technetium-95 and promethium-146. Many of these are
found in, and harvested from, spent nuclear fuel assemblies. Some must be manufactured
in particle accelerators.
Production
Some synthetic radioisotope are extracted from spent nuclear reactor fuel rods, which
contain various fission products. For example, it is estimated that up to 1994, about 49,000 TBq
(78 metric ton) of technetium was produced in nuclear reactors, which is by far the dominant
source of terrestrial technetium. However, only a fraction of the production is used
commercially. Other synthetic isotopes are produced in significant quantities by fission but are
not yet being reclaimed. Other isotopes are manufactured by neutron irradiation of parent
isotopes in a nuclear reactor (for example, Tc-97 can be made by neutron irradiation of Ru-96)
or by bombarding parent isotopes with high energy particles from a particle accelerator.
Uses
Most synthetic radioisotopes are extremely radioactive and have a short half life.
Though a health hazard, radioactive materials have many medical and industrial uses.
Nuclear medicine
The general field of nuclear medicine covers any use of radioisotopes for diagnosis or
treatment.
Diagnosis
Radioactive tracer compounds are used to observe the function of various organs
and body systems. These compounds use a chemical tracer which is attracted to or concentrated
by the activity which is being studied. That chemical tracer incorporates a short lived
radioactive isotope, usually one which emits a gamma ray which is energetic enough to travel
through the body and be captured outside by a gamma camera to map the concentrations.
Gamma cameras and other similar detectors are highly efficient, and the tracer compounds are
generally very effective at concentrating at the areas of interest, so the total amounts of
radioactive material needed are very small.The metastable nuclear isomer Tc-99m is a Gamma-
emitter widely used for medical diagnostics because it has a short half-life of 6 hours, but
can be easily made in the hospital using a "technetium-cow".
Treatment
Radiopharmaceuticals are any of a number of compounds using a radioisotope for

medical treatment, usually by bringing the radioactive isotope to a high concentration in the
body near a particular organ. For example, iodine-131 is used for treating some disorders and
tumors of the thyroid gland.
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4.4 RADIATION THERAPY
Radiation therapy uses ionising radiation to treat cancer i.e. to destroy cancerous cells.
There are two techniques in radiation therapy that are used to treat cancer using ionising
radiation:
• Radiotherapy
• Brachytherapy
Radiation Therapy
Radiotherapy Treatment Planning
Every treatment using radiotherapy has to be rigorously planned. The planning process consists
of three phases:
• Planning
• Simulation
• Treatment
Planning
The cancerous tumour has to be located so that its size and position can be analysed. This
information can be obtained from:
• X-rays
• CT scans
• MRI scans
• Ultrasound images
Simulation
Once the amount of radiation to be given has been accurately calculated, the patient then
goes to the simulator to determine what settings are to be selected for the actual treatment using a
linear accelerator. The settings are determined by taking a series of x-rays to make sure that the
tumour is in the correct position ready to receive the ionising radiation.
Treatment
Cancerous tumours can be treated using radiotherapy as follows:
• Irradiation using high energy gamma rays.
• Irradiation using high energy x-rays.
Irradiation Using High Energy Gamma Rays
• Gamma rays are emitted from a cobalt-60 source – a radioactive form of cobalt.
• The cobalt source is kept within a thick, heavy metal container.
• This container has a slit in it to allow a narrow beam of gamma rays to emerge.
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Figure 4.6 Radiation Therapy
Irradiation Using High Energy X-rays

• The x-rays are generated by a linear accelerator (linac).
• The linac fires high energy electrons at a metal target and when the electrons strike the
target, x-rays are produced.
The x-rays produced are shaped into a narrow beam by movable metal shutters
Radiotherapy
• The apparatus is arranged so that it can rotate around the couch on which the patient lies.
• This allows the patient to receive radiation from different directions.
• The diseased tissue receives radiation all of the time but the healthy tissue receives the
minimum amount of radiation possible.
• Treatments are given as a series of small doses because cancerous cells are killed more
easily when they are dividing, and not all cells divide at the same time – this reduces
some of the side effects which come with radiotherapy.
Brachytherapy
• This involves placing implants in the form of seeds, wires or pellets directly into the
tumour.
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• Such implants may be temporary or permenant depending on the implant and the tumour
itself.
• The benefit of such a method is that the tumour receives nearly all of the dose whilst
healthy tissue hardly receives any.
Brachytherapy is used to treat the following cancers

• Uterus
• Cervix
• Prostate
• Intraocular
• Skin
• Thyroid
• Bone
Tracers
There are many uses of ionising radiation based on the fact that it is easy to detect. In
such applications, the radioactive material is used in the form of a tracer.In nuclear medicine, a
tracer is a radioactive substance which is taken into the body either, as an injection, or as a drink.
Such a substance is normally a gamma emitter which is detected and monitored. This gives an
indication of any problems that may be present in body organs or tissues by how much, or how
little, of the substance has been absorbed.
Nuclear Medicine Tracers
It is important to be able to study internal organs, or tissues, without the need for surgery.
In such cases, radioactive tracers can be injected into the body so such studies can take place.
The path of these tracers can be detected using a gamma camera because of their radioactivity.
Such tracers consist of two parts:

• A drug which is chosen for the particular organ that is being studied.
• A radioactive substance which is a gamma emitter.
Factors Which Affect the Choice of Tracer

• They will concentrate in the organ, or tissue, which is to be examined.
• They will lose their radioactivity (short t).
• They emit gamma rays which will be detected outside the body.
• Gamma rays are chosen since alpha and beta particles would be absorbed by tissues and
not be detected outside the body.
• Technitium-99m is most widely used because it has a half-life of 6 hours.
The Gamma Camera

The tracer is injected into the patient. The radiation emitted from the patient is detected
using a gamma camera.A typical gamma camera is 40 cm in diameter – large enough to examine
body tissues or specific organs. The gamma rays are given off in all directions but only the ones
which travel towards the gamma camera will be detected.
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A gamma camera consists of three main parts:

• A collimator.
• A detector.
• Electronic systems.
The Collimator
• The collimator is usually made of lead and it contains thousands of tiny holes.
• Only gamma rays which travel through the holes in the collimator will be detected.
The Detector
• The detector is a scintillation crystal and is usually made of Sodium Iodide with traces of
Thallium added.
• The detector is a scintillation crystal and it converts the gamma rays that reach it into light
energy.
The Electronic Systems

• The electronic systems detect the light energy received from the detector and converts it
into electrical signals.
Diagnosis Static Imaging

• There is a time delay between injecting the tracer and the build-up of radiation in the
organ.
Static studies are performed on the brain, bone or lungs scans
Dynamic Imaging
• The amount of radioactive build-up is measured over time.
• Dynamic studies are performed on the kidneys and heart.
• Renograms are dynamic images of the kidneys and they are performed for the following
reasons:
• To assess individual kidney and/or bladder function.
• To detect urinary tract infections.
• To detect and assess obstructed kidney(s).
• To detect and assess vesico-ureteric reflux.
• To assess kidney transplant(s).
Performing the Renogram

• The tracer is injected into the patient.
• The radioactive material is removed from the bloodstream by the kidneys.
• Within a few minutes of the injection, the radiation is concentrated in the kidneys.
• After 10 – 15 minutes, almost all of the radiation should be in the bladder.
• The gamma camera takes readings every few seconds for 20 minutes.
The Renogram
• The computer adds up the radioactivity in each kidney and the bladder.
• This can be shown as a graph of activity versus time – a time-activity curve.
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Figure 4.7 The Renogram
Sterilisation
• Radiation not only kills cells, it can also kill germs or bacteria.
• Nowadays, medical instruments (e.g. syringes) are prepacked and then irradiation using
an intense gamma ray source.
• This kills any germs or bacteria but does not damage the syringe, nor make it
radioactive.
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UNIT V
RECENT TRENDS IN MEDICAL INSRUMENTATION
5.1 THERMOGRAPHY
Thermograph, thermal imaging, or thermal video, is a type of infrared imaging. Thermo

graphic cameras detect radiation in the infrared range of the electromagnetic spectrum (roughly
900–14,000 nanometers or 0.9–14 µm) and produce images of that radiation. Since infrared
radiation is emitted by all objects based on their temperatures, according to the black body
radiation law, thermograph makes it possible to see one's environment with or without visible
illumination.
The amount of radiation emitted by an object increases with temperature, therefore

thermograph allows one to see variations in temperature (hence the name). When viewed by
thermo graphic camera, warm objects stand out well against cooler backgrounds; humans and
other warm-blooded animals become easily visible against the environment, day or night. As a
result, thermograph’s extensive use can historically be ascribed to the military and security
services. Thermal imaging photography finds many other uses. For example, firefighters use it to
see through smoke, find persons, and localize the base of a fire.
With thermal imaging, power lines maintenance technicians locate overheating joints and
parts, a telltale sign of their failure, to eliminate potential hazards. Where thermal insulation
becomes faulty, building construction technicians can see heat leaks to improve the efficiencies of
cooling or heating air-conditioning.
Thermal imaging cameras are also installed in some luxury cars to aid the driver, the first
being the 2000 Cadillac Deville. Some physiological activities, particularly responses, in human
beings and other warm-blooded animals can also be monitored with thermo graphic imaging. The
appearance and operation of a modern thermo graphic camera is often similar to a camcorder.
Enabling the user to see in the infrared spectrum is a function so useful that ability to record their
output is often optional. A recording module is therefore not always built-in.Instead of CCD
sensors, most thermal imaging cameras use CMOS Focal Plane Array (FPA). The most common
types are InSb, InGaAs, HgCdTe and QWIP FPA.
The newest technologies are using low cost and uncooled microbolometers FPA sensors.
Their resolution is considerably lower than of optical cameras, mostly 160x120 or 320x240
pixels, up to 640x512 for the most expensive models. Thermo graphic cameras are much more
expensive than their visible-spectrum counterparts, and higher-end models are often export-
restricted. Older bolometer or more sensitive models as require cryogenic cooling, usually by a
miniature Stirling cycle refrigerator or liquid nitrogen.
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Methods of Thermography
Infrared thermography
Liquid crystal thermography
Microwave thermography.
5.1.1 INFRARED THERMOGRAPHY
Infrared thermography is the science of acquisition and analysis of thermal information by

using non contact thermal imaging devices.Human skin emits infrared radiation as an exponential
function of its absolute temperature and the emissive properties of the skin temperature.
The maximum wavelength λmax = 10 µm and range from 4 to 40µm.The thermal picture is
usually displayed on a TV tube may be photographed to provide a permanent record.
Chopper Detector Pre amplifier Demodulator
CRT
Body surface
Figure 5.1 Block diagram of Infrared thermograph
Every thermo graphic equipment is provided with a special infrared camera that scales the
object. The camera contains an optical system in the form of an oscillating plane mirror which
scans the field of view at a very high speed horizontally and vertically and focuses the collected
infrared radiations onto chopper.
The chopper disc interrupts the infrared beam so that a.c signals are produced. Then they
are given to detector. The detector is infrared radiation detector. The detected output by detector
is amplified and led to phase sensitive.
5.1.2 LIQUID CRYSTAL THERMOGRAPHY
Liquid crystals are a class of compounds which exhibit colour temperature sensitivity in
the cholestric phase. Scattering effects with the material give rise to iridescent colours, the
dominant wavelength being influenced by very small changes in temperature.
The high temperature sensitivity makes cholesteric liquid crystals useful for thermal
mapping.In this technique, the temperature sensitive plate consists of a blackened thin flim
support into which encapsulated liquid crystals cemented to a pseudo solid powder ( with particle
sizes between 10 to 30 ) have been incorporated.
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Thermal contact between the skin surface and plate produces a color change in the
encapsulated liquid crystals; red for relatively low temperatures through the visual spectrum to
violet for high temperatures. But in infrared thermograms, the violet colour is used to identify the
low temperature regions and the bright colour or red is used to identify the temperature regions.
If we want to study a breast’s temperature distribution, several different plates are

necessary to cover a breast temperature range from 280C to360C. Each plate covers a range of
temperature 30C. A record of the liquid crystal image may be obtained by colour photography.
The response time varies according to the thickness of plate ( ranges from 0.06mm to 0.3 mm)
and is 20 to 40 seconds.
5.1.3 MICROWAVE THERMOGRAPHY
Eventhough we get microwave emissions from the skin surface, that intensity is very
small when we compare with Infra red radiation intensity . (10 wavelenght emission intensity is
108 times greater than 10 cm wavelength emission intensity). But using modern microwave
radiometers one can detect temperature change of 0.1K. since body tissues are partially
transparent to microwave radiations which orginates from a tissue volume extending from the
skin surface to a depth of several centimeters. Microwave radiometers consisting of matched
antennae placed in contact with the skin surface for use at 1.3 G Hz and 3.3 G Hz have been used
to sense subcutaneous temperature.
The present day thermographic systems, using Infrared radiation, only give a temperature
map of the skin due to low penetration depth of the short wavelength of the infrared component of
the emitted radiation. Using a microwave receiver with a frequency response from 1.7 GHz to 2.5
GHz a penetration depth of 1 cm in tissue and 8 cm in fat and bone can be obtained.
A severe problem is the unknown emissivity of the body surface for microwaves, as part
of the radiation is reflected back into the body.In a conventional radiometer this gives rise toa
measurement error proportional to the temperature difference between the body surface and the
applied antenna. This error lies in the order of 1-2 K which is too high for medical applications.
The problem has been solved iv an elegant way by adding artificial microwave noise from
the antenna,thus providing a radiation balace between the receiver and body surface. With this a
temperature sensitivity of 0.1 K could be obtained. Based on the transducer attachment on the
skin surface, we can classify the thermography into contact thermography and tele-
thermography.
Advantages of Thermography
Get a visual picture so that you can compare temperatures over a large area
It is real time capable of catching moving targets
Able to find deteriorating components prior to failure
Measurement in areas inaccessible or hazardous for other methods
It is a non-destructive test method
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Limitations & disadvantages of thermography

Quality cameras are expensive and are easily damaged
Images can be hard to interpret accurately even with experience
Accurate temperature measurements are very hard to make because of emissivities
Most cameras have ±2% or worse accuracy (not as accurate as contact)
Training and staying proficient in IR scanning is time consuming
Ability to only measure surface areas
Applications
Healthy Cases
Tumors
Inflammation
Diseases of peripheral Vessels
Burns and Perniones
Skin Grafts and Organ Transplantation
Collagen diseases
Orthopedic Diseases
Brain and Nervous Diseases
Harmone Diseases
Examination of Placenta Attachment
5.2 ENDOSCOPY UNIT
HISTORY
The first endoscope, of a kind, was developed in 1806 by Philip Bozzini with his
introduction of a Lichtleiter (light conductor) for the examinations of the canals and cavities of
the human body. However, the Vienna Medical Society disapproved of such curiosity. An
endoscope was first introduced into a human in 1822 by William Beaumont, an army surgeon at
Mackinac Island, MichiganThe use of electric light was a major step in the improvement of
endoscopy. The first such lights were external. Later, smaller bulbs became available making
internal light possible, for instance in a hysteroscope by Charles David in 1908Hans Christian
Jacobaeus has been given credit for early endoscopic explorations of the abdomen and the thorax
with laparoscopy (1912) and thoracoscopy (1910).Laparoscopy was used in the diagnosis of liver
and gallbladder disease by Heinz Kalk in the 1930. Hope reported in 1937 on the use of
laparoscopy to diagnose ectopic pregnancyIn 1944, Raoul Palmer placed his patients in the
Trendelenburg position after gaseous distention of the abdomen and thus was able to reliably
perform gynecologic laparoscopy
The first gastrocamera was released in 1950 by Olympus Optical Co., Ltd. The device
took pictures on monochromatic film using a small light bulb that was triggered manually. The
device was of limited use, however, because it did not implement real-time optical capability.
Olympus continued its development of endoscopes by incorporating fiber optics in the early
1960s, leading to the first useful endoscopes. In 1964, it released a gastrocamera guided by a
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fiberscope. A few articles claim that Dr.Basil Hirschowitz of Univ.Of Michigan,Ann Arbor
discussed the endoscope in early 50's.
As endoscopic technology improved, so did the methods of gastrointestinal endoscopy.

Owing primarily to the efforts of Dr. Hiromi Shinya in the late 1960s, GI endoscopy developed
into what is more recognizable as today's colonoscopy. While many doctors experimented with
techniques to take advantage of the new iterations of endoscopes, Dr. Shinya focused on
techniques that would allow for successful operation of the endoscope by an individual, rejecting
the common practice at the time of utilizing two people. Consequently, many of the fundamental
methods and procedures of modern colonoscopy were developed by Dr. Shinya.
By 1980, laparoscopy training was required by gynecologists to perform tubal ligation

procedures and diagnostic evaluations of the pelvis. The first laparoscopic cholecystectomy was
performed in 1984 and the first video-laparoscopic cholecystectomy in 1987. During the 1990s,
laparoscopic surgery was extended to the appendix, spleen, colon, stomach, kidney, and liver .
Wireless capsule endoscopy or Capsule Endoscopy is now approved in all the countries including
Japan where government reimbusement will be available from Oct.2007.Capsule Endoscopy
increases detection of Small Bowel tumors where traditional Endoscopy is not very efficient.
Endoscopy
An endoscopy is a test that looks inside the body. The endoscope is a long flexible tube that
can be swallowed. It has a camera and light inside it. Some doctors call it a telescope.Most likely
to have an endoscopy to look at the inside of
Gullet (oesophagus)
Stomach
Duodenum - the first part of the small bowel that attaches to the stomach
Large bowel (colon)
There is more detailed information about having a colonoscopy in the bowel

cancer section of CancerHelp UK. Below is information about having other types of endoscopy.
Figure 5.2 A flexible endoscope.
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Figure 5.3 Observation using Endoscopy
Reflected light rays are collected by CCD( Charge coupled device) and electrical signals
are produced, which are fed to the video monitor to get image.Thorough one channel of
endoscope water and air is conducted to wash and dry the surgical site.The endoscope also has a
channel through which surgeons can manipulate tiny instruments, such as forceps, surgical
scissors, and suction devices.
A variety of instruments can be fitted to the endoscope for different purposes.A surgeon
introduces the endoscope into the body either through a body opening, such as the mouth or the
anus, or through a small incision in the skin.The endoscope gives visual evidence of the problem,
such as ulceration or inflammation It can be used to collect a sample of tissue; remove
problematic tissue, such as polyps.It is used to take photograph of the hollow internal organs
Depending on the body part, each type of endoscopy has its own special term, such as
laparoscopy (abdomen, uterus, fallopian tube),
laryngoscopy (vocal cords),
bronchoscopy (lungs),
colonoscopy (colon),
arthroscopy (joint) and
Gastroscopy (Stomach).
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Components
An endoscope can consist of
 A rigid or flexible tube

 A light delivery system to illuminate the organ or object under inspection. The light
source is normally outside the body and the light is typically directed via an optical fiber
system A lens system transmitting the image to the viewer from the fiberscope
 An additional channel to allow entry of medical instruments or manipulators
Uses
Endoscopy can involve
The gastrointestinal tract (GI tract):
esophagus, stomach and duodenum (esophagogastroduodenoscopy)
small intestine
colon (colonoscopy,proctosigmoidoscopy)
Bile duct
 The respiratory tract
 The nose (rhinoscopy)
 The lower respiratory tract (bronchoscopy)
 The urinary tract (cystoscopy)
 The female reproductive system
 The cervix (colposcopy)
 The uterus (hysteroscopy)
 The Fallopian tubes (Falloscopy)
 Normally closed body cavities (through a small incision):
 The abdominal or pelvic cavity (laparoscopy)
 The interior of a joint (arthroscopy)
 Organs of the chest (thoracoscopy and mediastinoscopy)
 During pregnancy
 The amnion (amnioscopy)
 The fetus (fetoscopy)
 Plastic Surgery
 Panendoscopy (or triple endoscopy)
 Combines laryngoscopy, esophagoscopy, and bronchoscopy
Non-medical uses for endoscopy
The planning and architectural community have found the endoscope useful for pre-
visualization of scale models of proposed buildings and cities (architectural endoscopy) Internal
inspection of complex technical systems (borescope) Endoscopes are also a tool helpful in the
examination of improvised explosive devices by bomb disposal personnel. The FBI uses
endoscopes for conducting surveillance via tight spaces.
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Risks
Infection
Punctured organs
Allergic reactions due to Contrast agents or dyes (such as those used in a CT scan)
Over-sedation
After The Endoscopy
After the procedure the patient will be observed and monitored by a qualified individual in the
endoscopy or a recovery area until a significant portion of the medication has worn off.
Occasionally a patient is left with a mild sore throat, which promptly responds to saline gargles,
or a feeling of distention from the insufflated air that was used during the procedure. Both
problems are mild and fleeting. When fully recovered, the patient will be instructed when to
resume his/her usual diet (probably within a few hours) and will be allowed to be taken home.
Because of the use of sedation, most facilities mandate that the patient is taken home by another
person and not to drive on his/her own or handle machinery for the remainder of the day.
Recent developments
With the application of robotic systems, telesurgery was introduced as the surgeon could operate
from a site physically removed from the patient. The first transatlantic surgery has been called the
Lindbergh Operation.
Upper Endoscopy
Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum
(first part of the small intestine). The procedure might be used to discover the reason for
swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest
pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-
SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).
Figure5.4 Upper Endoscopy

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For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-
doh-skope). Right before the procedure the physician will spray your throat with a numbing agent
that may help prevent gagging. You may also receive pain medicine and a sedative to help you
relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach,
and duodenum, so the physician can carefully examine the lining of these organs. The scope also
blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to
examine the stomach.
The physician can see abnormalities, like inflammation or bleeding, through the
endoscope that don't show up well on x rays. The physician can also insert instruments into the
scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further
tests.Possible complications of upper endoscopy include bleeding and puncture of the stomach
lining. However, such complications are rare. Most people will probably have nothing more than
a mild sore throat after the procedure.The procedure takes 20 to 30 minutes. Because you will be
sedated, you will need to rest at the endoscopy facility for 1 to 2 hours until the medication wears
off.
Preparation
Stomach and duodenum must be empty for the procedure to be thorough and safe, will not
be able to eat or drink anything for at least 6 hours beforehand. Also, must arrange for someone to
take home—will not be allowed to drive because of the sedatives. Physician may give other
special instructions.
Need of Endoscopy
Endoscopy allows physicians to peer through the body's passageways. Endoscopy is the
examination and inspection of the interior of body organs, joints or cavities through an
endoscope. An endoscope is a device that uses fiber optics and powerful lens systems to provide
lighting and visualization of the interior of a joint. The portion of the endoscope inserted into the
body may be rigid or flexible, depending upon the medical procedure.
An endoscope uses two fiber optic lines. A "light fiber" carries light into the body cavity
and an "image fiber" carries the image of the body cavity back to the physician's viewing lens.
There is also a separate port to allow for administration of drugs, suction, and irrigation. This port
may also be used to introduce small folding instruments such as forceps, scissors, brushes, snares
and baskets for tissue excision (removal), sampling, or other diagnostic and therapeutic work.
Endoscopes may be used in conjunction with a camera or video recorder to document images of
the inside of the joint or chronicle an endoscopic procedure. New endoscopes have digital
capabilities for manipulating and enhancing the video images.
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Figure 5.5 Rigid endoscope
This figure shows a rigid endoscope used for arthroscopy. The "image fiber" leads from
the ocular (eye piece) to the inserted end of the scope. The "light fiber" is below and leads from
the light source to the working end of the endoscope.
Performance of Endoscopy
Endoscopy can be used to diagnose various conditions by close examination of internal

organ and body structures. Endoscopy can also guide therapy and repair, such as the removal of
torn cartilage from the bearing surfaces of a joint. Biopsy (tissue sampling for pathologic testing)
may also be performed under endoscopic guidance. Local or general anesthetic may be used
during endoscopy, depending upon the type of procedure being performed
Internal abnormalities revealed through endoscopy include: abscesses, biliary (liver)

cirrhosis, bleeding, bronchitis, cancer, cysts, degenerative disease, gallbladder stones, hernia,
inflammation, metastatic cancer, polyps, tumors, ulcers, and other diseases and conditions.
Endoscopy is a minimally invasive procedure and carries with it certain minor risks
depending upon the type of procedure being performed. However, these risks are typically far
outweighed by the diagnostic and therapeutic potential of the procedure.
Prior to the widespread use of endoscopy and diagnostic imaging, most internal conditions
could only be diagnosed or treated with open surgery. Until the last several decades, exploratory
surgery was routinely performed only when a patient was critically ill and the source of illness
was not known. For example, in certain dire cases, the patient's thorax or abdomen were
surgically opened and examined to try to determine the source of illness.
Endoscopy can often be done on an outpatient basis. "Outpatient" means that the
procedure does not require hospital admission and acute care and observation and may be
performed outside the premises of a hospital. Outpatient procedures performed at hospitals or
ambulatory centers allow the patient to go home or return to work within a short while after their
procedure.
Types of Endoscopy
Fiber optic endoscopes now have widespread use in medicine and guide a myriad of diagnostic
and therapeutic procedures including:
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Arthroscopy: Examination of joints for diagnosis and treatment (arthroscopic surgery)
Bronchoscopy: Examination of the trachea and lung's bronchial trees to reveal abscesses,
bronchitis, carcinoma, tumors, tuberculosis, alveolitis, infection, inflammation
Colonoscopy: Examination of the inside of the colon and large intestine to detect polyps, tumors,
ulceration, inflammation, colitis diverticula, Chrohn's disease, and discovery and removal of
foreign bodies.
Colposcopy: Direct visualization of the vagina and cervix to detect cancer, inflammation, and
other conditions.
Cystoscopy: Examination of the bladder, urethra, urinary tract, uteral orifices, and prostate (men)
with insertion of the endoscope through the urethra.
ERCP (endoscopic retrograde cholangio-pancreatography) uses endoscopic guidance to place

a catheter for x-ray fluorosocopy with contrast enhancement. This technique is used to examine
the liver's biliary tree, the gallbladder, the pancreatic duct and other anatomy to check for stones,
other obstructions and disease. X-ray contrast is introduced into these ducts via catheter and
fluoroscopic x-ray images are taken to show any abnormality or blockage. If disease is detected, it
can sometimes be treated at the same time or biopsy can be performed to test for cancer or other
pathology. ERCP can detect biliary cirrhosis,.cancer of the bile ducts, pancreatic cysts,
pseudocysts, pancreatic tumors, chronic pancreatitis and other conditions such as gallbladder
stones.
EGD (Esophogealgastroduodensoscopy): visual examination of the upper gastro-intestinal (GI)

tract. (also referred to as gastroscopy) to reveal hemorrhage, hiatal hernia, inflammation of the
esophagus, gastric ulcers.
Endoscopic biopsy is the removal of tissue specimens for pathologic examination and analysis.
Gastroscopy: examination of the lining of the esophagus, stomach, and duodenum. Gastroscopy
is often used to diagnose ulcers and other sources of bleeding and to guide biopsy of suspect GI
cancers.
Laparoscopy: visualization of the stomach, liver and other abdominal organs including the
female reproductive organs, for example, the fallopian tubes.
Laryngoscopy: examination of the larynx (voice box).
Proctoscopy, sigmoidoscopy, proctosigmoidoscopy: examination of the rectum and sigmoid

colon.
Thoracoscopy: examination of the pleura (sac that covers the lungs), pleural spaces,
mediastinum, and pericardium.
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Endoscopy Equipment
Endoscopes have many practical needs. And H.M.B. Endoscopy Products (Hollywood, Florida)
has been providing endoscopic equipment and educating people on the use of endoscopes for
more than 17 years..
Figure 5.6 Endoscopic Equipment
In the simplest terms, Endoscopy equipment consists of instruments that can look at the
inside of many different organs — these are small, flexible or rigid tubes with a light or lenses on
the end that can look into the esophagus, stomach and colon — and in more general terms
endoscopy equipment can help doctors look deep inside body structures and hollow organs. An
endoscope and related endoscope products and equipment are usually composed of three
components:
An optic system that allows the doctor to look through the scope into the organ or cavity, or to
attach a video camera to the scope
A fiberoptic cable to light up the bodily area
A lumen (e.g. the bore of a tube, like a needle or catheter) to take tissue samples of the area being
viewed
5.3 LASERS IN MEDICINE
LASERS (Light Amplification by Stimulated Emission of Radiation)
Characteristics of laser sources

•Tissue optical properties
•Laser/tissue interactions
•Some diagnostic applications
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Components of a Laser
a) Lasing Medium: provides appropriate transition and determines wavelength.Solid: Ruby, v

Nd:YAG, Ti:Sapphire, etc. Liquid: Organic dyes, e.g. rhodamine Gas: Ar, CO2, HeNe, ArF, etc.
b) Pump: provides energy necessary for population inversion.

E.g. electric discharge, flashlamp, another laser.
c) Cavity: provides opportunity for amplification and produces a directional beam.
Figure 5.7 Components of Laser
Useful Characteristics of Output Beam

a) Coherence
b) Collimation
c) Monochromaticity
d)Widerangeofpulsestructure
e) High power
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Optical Properties of Tissues
Scattering
 Elastic (i.e. no energy loss), although Doppler shift and Raman shift have been exploited for
diagnostic information.
 Mean free path for scattering is typically 100 microns.
 Scattering is forward peaked, typically the average cosine of the scattering angle is > 0.9 (for isotropic scatt
 Scattering coefficient decreases slowly as a function of wavelength.
Absorption
Depends on concentration and absorption spectra of specific molecules in the tissue. Highly
dependent on wavelength. UV - high absorption by proteins.Visible - can identify specific features
of absorption by hemoglobin, melanin, and other pigments.700 - 900 nm - the “optical window”
where tissue absorption is low, maximum light penetration in tissue.IR - absorption is mainly due to
water, highest at 2.95 microns.
Figure 5.8 Aborption vs wavelength
Distribution of Light in Tissue
The quantity we are usually interested in is the fluence rate. This is defined as the ratio of
total power incident on an infinitesimal sphere to the cross sectional area of that sphere. The SI unit
is W m-2. It is a measure of how many photons are available per unit volume in the tissue.The
fluence rate distribution in tissue is highly dependent on the absorption and scattering coefficents of
the tissue.
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The beam is incident on tissue at two different wavelengths:300 nm and 700 nm. At 300 nm the
“effective” scattering coefficient is 1 mm-1 and the absorption coefficient is 10 mm-1. At 700 nm, let
us assume the scattering is the same but the absorption coefficient is only 0.005 mm-1.
Mechanisms of interaction
In order for light to affect tissue, absorption must take place. The rate at which energy is
deposited in the tissue is given by the product of the fluence rate (W cm-2) and the linear absorption
coefficient (cm-1). The rate of energy absorption largely determines whether photochemical, thermal,
or photomechanical effects are dominant.
Photochemical
Initial absorption by specific molecules.If photon energy is high enough (UV, excimer laser),
direct bond- breaking is possible.Alternatively, the molecule can be raised to an excited state from
which a variety of chemical reactions are possible such as the generation of free radicals and reactive
oxygen species.
Photomechanical
For very high rates of energy deposition, shock waves can be generated in the tissue by
mechanisms such as bubble expansion/collapse or plasma formation.The mechanical properties of the
tissue govern the propagation of these waves and their biological effect.
Tissue can be ablated (i.e. physically removed from the surface, torn or, in the case of “brittle”
tissue, shattered. Interestingly, these two quantities span many orders of magnitude but their product
(the light fluence), varies over a much smaller range. This emphasizes the point that is is the rate of
energy absorption that determines the nature of the light-tissue interaction.
Selected Applications of Lasers in Medicine

Diagnostic: Goal is to learn something about the tissue
Therapeutic: Goal is to modify the tissue, e.g. kill malignant cells.
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Optical spectroscopy
Figure 5.9 Optical Spectroscopy
Endogenous absorbers: Hemoglobin, proteins, melanin, water
Endogenous fluorophores: Collagen, elastin, NADH
Fluorescence Spectroscopy
Noninvasive tissue characterization to replace or guide physical biopsy, e.g. early diagnosis of
lung cancer.
Figure 5.10 Diagnosis of lung cancer
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Figure 5.11 Fluorescence Spectroscopy
Images are acquired at the two wavelengths shown, and a ratio image is computed and
displayed to the physician in real time. This application uses coherence and collimation of the laser
toachieve efficient coupling to the fiber and endoscopic light delivery. In addition, the choice of laser
(HeCd) provides optical power at the optimum wavelength for fluorescence excitation.
Photodynamic Therapy
Use chemical reactions initiated by light absorption to kill cells. Original application in
oncology but is applicable to other diseases, including age-related macular degeneration caused by a
proliferation of new blood vessels in the retina.
Figure5.12 Photodynamic Therapy
Process:
1. Inject photosensitizer or apply topically.
2. Possibly wait for biodistribution.
3. Irradiate with light of appropriate wavelength.
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Recent advances:
1. Long wavelength photosensitizers.
2. Reliable clinical diode lasers.
3. Better targetting of photosensitizers
Selective Destruction of Blood Vessels
Figure5.13 Selective Destruction of Blood Vessels
Port Wine Stain: Congenital hypervascularization of the dermis.Could just ablate the epidermis
and dermis but this would result in unacceptable scarring. Instead, develop a strategy to target the
blood vessels:
Wavelength;
The vessels are filled with hemoglobin - most of it oxygenated. Oxyhemoglobin has a strong
absorption peak at 577 nm.
Thermal confinement:
Use a pulsed laser to heat the blood in a time short compared with the “thermal relaxation time
of the vessel.
Solution:
Pulsed dye laser (ms pulses) tuned to 577 nm.
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5.4 DIATHERMY UNITS
Definition: Diathermy is the treatment process by which cutting, coagulation of tissues are
obtained.
 Application of high-frequency electromagnetic energy

 Used to generate heat in body tissues
 Heat produced by resistance of tissues
 Also used for non-thermal effects
Advantages:
 Treatment can be controlled easily.

 Use of appropriate electrodes permit the heat to be localized only in the region to
be treated.
 Amount of heat that is to be delivered can be adjusted accurately.
 Inter lying tissues, muscles, bones, internal organs, etc, can be provided with heat
by using high frequency
Physiologic Responses To Diathermy
 Not capable of producing depolarization and contraction of muscles

 Wavelengths too short
Physiologic Effects Are Those of Heat In General
 Tissue temperature increase

 Increased blood flow (vasodilation)
 Increased venous and lymphatic flow
 Increased metabolism
 Changes in physical properties of tissues
 Muscle relaxation
 Analgesia
Diathermy Heating
Doses are not precisely controlled thus the amount of heating cannot be accurately
measured
Heating= Current2 X Resistance
Types of diathermy
 Shortwave diathermy
 Ultrasonic diathermy
 Microwave diathermy
 Surgical diathermy
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5.4.1 SHORTWAVE DIATHERMY
 Power supply powers radio frequency oscillator (RFO)

 RFO provides stable drift-free oscillations at given frequency
 Power amplifier generate power to drive electrodes
 Output resonant tank tunes in the patient for maximum power transfer
Figure5.15 Short wave diathermy unit
• Power output should provide energy to raise tissue temp to therapeutic range (40-45 deg
c) (80-120 watts)
• Should exceed sar-specific absorption rate (rate of energy absorbed /unit area of tissue
mass)
• Generates both an electrical and a magnetic field
SWD Electrodes
• Capacitor electrodes
• Inductor electrodes
• Selection of appropriate electrodes can influence the treatment
5.4.1.1 Capacitor Electrodes
 Create stronger electrical field than magnetic field

 Ions will be attracted or repelled depending on the charge of the pole
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Figure5.16 Capacitor Electrodes

• Electrical field is the lines of force exerted on charged ions that cause movement from
one pole to another
• Center has higher current density than periphery
• Patient is between electrodes and becomes part of circuit
• Tissue is between electrodes in a series circuit arrangement
• The tissue that offers the greatest resistance to current flow develops the most heat
• Fat tissue resists current flow
• Thus fat is heated in an electrical field
• Typical with capacitor electrodes
Air Space Plates
Figure 5.17 Air Space plates

• Two metal plates surrounded by plastic guard
• Can be moved 3cm within guard
• Produce high-frequency oscillating current
• When overheated discharges to plate of lower potential
• Area to be treated is placed between electrodes becoming part of circuit
• Sensation of heat in direct proportion to distance of electrode from skin
• Closer plate generates more surface heat
• Parts of body low in subcutaneous fat best treated
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Pad Electrodes
• Greater electrical field

• Patient part of circuit
• Must have uniform contact (toweling)
• Spacing equal to cross-sectional diameter of pads
• Part to be treated should be centered
• Increasing the spacing will increase the depth of penetration but will decrease the current
density
5.4.1.2 Induction Electrodes
Creates a stronger magnetic field than electrical field. A cable or coil is wrapped
circumferentially around an extremity or coiled within an electrode
Figure5.18 Induction Electrode
 Passing current through a coiled cable creates a magnetic field by inducing eddy currents
(small circular electrical fields) that generate heat
 Patient in a magnetic field not part of a circuit
 Tissues in a parallel arrangement
 Greatest current flow through tissue with least resistance
 Tissue high in electrolytic content respond best to a magnetic field
Cable Electrode
Two arrangements:
Pancake coils
Wraparound coils
Toweling is essential
Pancake coil must have 6” in center then 5-10cm spacing between turns
Drum Electrode
One or more monopolar coils rigidly fixed in a housing unit
May use more than one drum depending on area treated.
Toweling important.
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5.4.2 ULTRASONIC DIATHERMY
Timer
Intensity and RF control Piezo-electric

frequency control transducer
Ultrasonic wave
output
Figure 5.19 Block diagram of Ultrasonic diathermy
 It is used for curing the diseases of peripheral nervous system, skeletal muscle system and
skin ulcers.
 It is adopted when the short wave treatment has failed and it helps to achieve the
localization of heart to the affected part.
 The heating effect is produced in the tissues by the absorption of ultrasonic energy. The
absorption effect is similar to that of a micro massage.
 It is better than the manual massage because the micro massage provides a greater depth
of massage without causing any pain to the patient.
 Piezo-electric transducer is excited by the high frequency alternating current produced by
the Rf oscillator.
 Ultrasonic wave from the piezo electric transducer is used for the purpose of treatment.
 It can be applied in continuous mode or pulse mode.
 Frequency range of 800 KHz to 1MHz is suitable for the ultrasonic method of treatment
.5.4.3 MICROWAVE DIATHERMY
 In this method the tissues are heated by the absorption of microwave energy. The
frequency used is about 2450 MHz.
 Better results are obtained by the microwave method and it is more advantageous than the
short wave method.
 There is no pad electrodes and flexible cable.
 Microwave is transmitted into body and treat directly from the direction of unit.
 Microwaves are produced with the help of magnetron
 Proper cooling arrangements are made for the purpose of cooling the magnetron
Precautions
 Necessary precautions should be taken during this method of treatment

 Excessive dosage causes skin burns and the skin should be dry as the waves are
rapidly absorbed by water.
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Disadvantages
 Patients with implanted pacemaker should not undergo this treatment

 There are possibilities of over heating
 Care should be taken while the treatment is made near the eyes.
5.4.4. SURGICAL DIATHERMY
Control panel Audio tone

generator
Logic Board
Isolator switch Power output
Board Board
Foot Switch
Power Supply
Figure 5.20 Block diagram of electrosurgical diathermy
 Logic board is the main part of the unit which produces the necessary waveforms for
cutting, coagulation and hemostasis modes of operation.
 An astable multivibrator generates 500 kHz square pulses. The output from this oscillator
is divided into a number of frequencies using binary counters.
 These frequencies are used as system timing signals, A frequency of 250 KHz provides a
split phase signal to drive output stages on the power output board.
 Frequency of 250 Hz is used for cutting , after the high power amplification by push pull
amplifier.
 The output of the push pull amplifier is given to a transformer so that the voltage is
stepped up and the output signal from the unit is well isolated.
 The isolator switch provides an isolated switching control between the active hand switch
and the rest of the unit.
5.5 ELECTRICAL SAFETY OF MEDICAL EQUIPMENT
The patient in hospital is the center of care, but he is also helpless in the center of
potential dangers, which are in the industry, long time ago, as such identified (i.e. chemicals,
electricity, radiation).Safety in hospital means firstly patient safety, but it means also safety of
operators and others.Electrical safety is a very important element in hospital safety. The electrical
safety of the medical equipment in hospital is the most important of it.
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Medical. Enggineering. & El. Safety
Assurance the highest possible level of med. Equipment safety in hospital is one of the
most important tasks of the med. / clinical engineer.The med. / clinical engineer, therefore, must
be aware of and very familiar with the issues of the electrical safety of the medical equipment in
hospital. Electrical Safety means electrical shock protection.
The Mechanism of the El. Shock
El. Shock occurs when a victim is a part of an electrical circuit (an element closing it), in
which an electrical current can flow and has the ability to harm the victim or even cause death
(electrocution).That means consequently that there must be a simultaneous two-points contact of
the victim with the electrical shock circuit.
El. Shock = Closing the El. Shock Circuit
El. Power Distribution System
For technical reasons, neutral point (and consequently the neutral line) is deliberately
connected to earth. It is this connection that makes the electrical service a “grounded
system”.Understanding this is the key for understanding the mechanism of electric shock and
electrocution.The voltage between the two power-carrying wires (Phase (P) & Neutral (N) or
“hot & cold”) is also present between Phase and Ground (which is not considered as power-
carrying wire) and every thing connected to earth.
Figure 5.21Power distribution system
Two Kinds of Grounding / Earthing
Grounding of Electrical Systems:
Connecting N-line of the service side to earth due to technical reason and for protection of
systems and plants (removing the floating high voltage in the secondary (service) side of the
distribution transformer).
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Protective Grounding:
Connecting conducting parts, which are not intended for carrying current in normal
circumstances (enclosures; switch-, fuse-, outlet- metal boxes; etc.) via 3rd conductor (which, in
normal situations, does not carry current) to earth.
Figure5.22 Basic shock circuit
Leakage Currents: Caused by stray capacitances, which are always present between
conducting surfaces.
Figure 5.23 Stray capacitance and leakage current
Leakage Current & Fault Current
Due to the relatively low values of the stray capacitances and frequency, the resulting el.
Pathway is very high resistive , and hence, the resulting leakage currents are very
low.Distinguishing between leakage and fault current depends on the internal resistance of the
source in relation to the load in a given circuit.
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MACRO-SHOCK:
External or touch - current shock (voltage applied externally, current pass through the skin in
and out
Figure 5.24 Macro shock
MICRO-SHOCK
Current affect heart directly (through pacemaker leads or catheter) Currents less than
(100) micro-Ampere have the potential to cause VF (it is possible from (25) micro-Ampere up).
Figure 5.25Micro shock
Methods of Protection Against El. Shock
 Over-current protection (indirect protection).

 Protective earthing (grounding).
 Double insulation.
 Low voltage power supply.
 Differential circuit breaker (Ground Fault Circuit Interrupter GFCI) .
 Isolated power system (IPS).
SCE 132 DEPT.OF ECE

Protective Earthing
Simple, efficient, and inexpensive, but it is not “fail-safe” (i.e. if it fails, equipment does
not go in a safe mode (alarm, power interruption for example)).
Double insulation
All surfaces which can be contacted are made of non- conductive materials, or all voltage
carrying parts are double insulated. Equipment protected this way are referred to as class II, and
need not to be earthed.
Low Voltage Supply
 Referred to as class III.

 Supply voltage less than 50 Volt.
 Equipment need not to be earthed.
 For wet areas: voltage less than 25 Volt.
 If skin immersed in water: voltage less than 12 Volt.
 If supply is via transformer, then primary and secondary must be galvanically separated.
Differential Circuit Breaker &GFCI
If difference between currents in “hot” and neutral wires is more than 6 mA, the circuit
breaker is activated within 5 ms.
Isolated Power System (IPS) & Isolation Transformer
Isolation transformer is used to omit the ground connection so that the el. System on
service side is no more “ground seeking
Figure 5.26 Isolation Transformer
 IPS & Line Isolation Monitor (LIM)

 IPS are not 100% isolated. It has certain “resistance” to earth (caused by stray
capacitances).
SCE 133 DEPT.OF ECE

 LIM measure this resistance.The monitored value in LIM represent a virtual current
which would flow if a short-circuit occurred between a power carrying line and earth
(prognostic value, worst case condition).
 LIM gives audio-visual alarm if the a.m. prognostic value exceeds 5 mA (USA standard).
 The 5 mA could be annoying, but it is normally not dangerous.
 Grounding of the equipment is independent of the power system (isolated or not).
IPS Applications
 IPS is a protection against macro-shock. It is not (and has never been) a protection
against micro-shock ( even if it makes the related safety level higher).
 IPS is necessary for operation theatres (OT), but is not necessary (and not
required) for ICU.
Hazard due to ungrounded lamp
(lamp failure → lamp metal cover carries voltage → patient connected to grounded equipment
touches cover → current path through patient to earth)
Figure 5.27 Hazard due to ungrounded lamp
Protection through non-conductive signal transfer (lamp failure → lamp metal cover
carries voltage → patient connected to grounded equipment (but here via battery operated
amplifier which is connected to equipment via glass fiber ) touches cover → no current path
through patient to earth).
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Figure 5.27 Hazard due to lamp failure
Hazards due to using open sockets (extensions)
Figure 5.28 Hazards due to using open sockets
If patient connected to more than one equipment , and the equipment are powered from a
socket-block, then the connection of the patient with the ground must be through one wire only.
Figure 5.29 Connection of the patient with the ground be through one wire
SCE 135 DEPT.OF ECE

Rules for Med. Equipment Electrical Safety
 Equipment connected to a patient to be powered from one socket, or a block of

sockets having the same protective grounding point.
 All metal subjects in the vicinity of the patient to be grounded one at a time with
the same protective ground point.
 Patient to be connected to the common ground through only one grounding pole.
 Isolation amplifiers to be used for measurements if possible.
 If possible, avoid using material which can be charged electro-statically .
 Deal carefully with electric wires and sockets and let it be checked periodically.
Do not use extension cables. Do not use faulty cables / plugs and ask for
replacement.
 If an equipment has a failure, which can cause electric shock, it has to be taken out
of service immediately. Reversing the plug (this “advice” is heard often) , which
might lead to eliminate the shock, is a wrong action / behavior.
 If, by touching the metallic surface of an equipment, you sensed an electric prickle
(even a light one), then plug off the equipment immediately and ask for check.
This equipment is either badly earthed or not earthed at all.
 Do not use any medical equipment you do not know the basics of its operation and
did not read its instruction manual carefully.
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Glossary
Unit -I
Half Cell Potential - A characteristic potential difference established by the electrode and its
surrounding electrolyte which depends on the metal, concentration of ions in solution and
temperature.
Polarization - If there is a current between the electrode and electrolyte, the observed half cell
potential is often altered due to polarization.
Biopotential amplifiers - Biopotential amplifiers are required to increase signal strength while
maintaining fidelity
Electrocardiograph - A very widely used medical instrument, which is utilized to diagnose and
monitor cardiac beat abnormalities, is the electrocardiograph
Myocardium - The walls of the heart are composed of cardiac muscle, called myocardium.
EEG - EEG is the recorded representation of bioelectric potentials generated by the neuronal
activity of the brain.
Grand mal epilepsy – Sudden loss of consciousness, falling down, tonic contractions (stiffening
of muscles) followed by twitching and jerking movements of the limbs
Surface electrodes- Usually this electrode is used for EMG. But by using this electrode, it is not
possible to take the deeper potential.
Needle electrodes – These are inserted into tissue or closer to tissue to measure the electrical
activity of muscle.
EMG - It is an instrument used for recording the electrical activity of the muscles to determine
whether the muscle is contracting or not.
EOG - It is the recording of the biopotentials generated by the movement of eyes
Unit –II
PH Measurement - The chemical balance in the body can be determined by the ph value of
blood and other body fluids.ph is defined as the hydrogen ion concentration of a fluid
po2 - po2 is defined as the partial pressure of oxygen respectively
Vitro Measurements - The blood sample is taken and the measurement for oxygen saturation is
made in the laboratory.
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Vivo Measurements - The oxygen saturation is determined while the blood is flowing in the
circulatory system
pCO2 Measurement - pco2 is defined as the partial pressure of carbon dioxide respectively
Electrophoresis – It is defined as the movement of a solid phase with respect to a liquid.
Colorimeter - Measures the color concentration of a substance in a solution by detecting the

color light intensity passing through a sample containing the substance and a reagent
Beer’s Law - If the path length or concentration increases, the transmittance decreases and
absorbance increases
Autoanalyzer - An auto analyzer sequentially measures blood chemistry through a series of

steps of mixing, reagent reaction and colorimetric measurements.
Dialyzer: separates interfacing substances from the sample by permitting selective passage of
sample components through a semi permeable membrane
Unit III
Pacemakers - A device capable of generating artificial pacing impulses and delivering them to
heart is known as pacemaker system or pacemaker
External stimulation- Used to restart the normal rhythm of the heart in case of cardiac
standstill.
Internal stimulation-It prevents normal self triggering of the heart.
Dc Defibrillation - a capacitors charged to a high dc voltage and then rapidly discharged through
electrodes across the chest of patient.
Anterior-anterior paddles are applied to the chest. Anterior-posterior paddles are applied to
both the patients chest wall and back so that energy is delivered through the heart.
Telemetry - Telemetry is a technology that allows remote measurement and reporting of

information.
Motorracing - Motor racing, allowing race engineers to interpret the vast amount of data
collected during a test or race, and use that to properly tune the car for optimum performance
SCE 138 DEPT.OF ECE

Unit IV
Ionizing Radiation - ionizing radiation is harmful and potentially lethal to living beings but can
have health benefits in radiation therapy for the treatment of cancer and thyrotoxicosis.
Deterministic effects- (harmful tissue reactions) due in large part to the killing/ malfunction of
cells following high doses
Stochastic effects, i.e., cancer and heritable effects involving either cancer development in
exposed individuals owing to mutation of somatic cells or heritable disease in their offspring
owing to mutation of reproductive (germ) cells.
Alpha particles - Alpha particles consist of two protons and two neutrons bound together into a
particle identical to a helium nucleus
Beta particles - Beta particles are high-energy, high-speed electrons or positrons emitted by
certain types of radioactive nuclei, such as potassium-40
Positron - The positron or ant electron is the antiparticle or the antimatter counterpart of the
electron.
Cancer - Cancers are growths of cells (cancerous tumours) which are out of control. As a result
of this, they do not perform their intended function
Static Imaging - There is a time delay between injecting the tracer and the build-up of radiation
in the organ. Static studies are performed on the brain, bone or lungs scans
Collimator - It is placed between the patient and aluminium filter. It is nothing but an aperture
Unit V
Thermograph - Thermograph, thermal imaging, or thermal video, is a type of infrared imaging
Infrared thermography - is the science of acquisition and analysis of thermal information by

using non contact thermal imaging devices
Liquid Crystal Thermography - Liquid crystals are a class of compounds which exhibit
colour temperature sensitivity in the cholestric phase
Endoscopy - An endoscopy is a test that looks inside the body. The endoscope is a long
flexible tube that can be swallowed. It has a camera and light inside it. Some doctors call it a
telescope
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Upper Endoscopy - Upper endoscopy enables the physician to look inside the esophagus,
stomach, and duodenum (first part of the small intestine)
Arthroscopy: Examination of joints for diagnosis and treatment (arthroscopic surgery)
Bronchoscopy: Examination of the trachea and lung's bronchial trees to reveal abscesses,
bronchitis, carcinoma, tumors, tuberculosis, alveolitis, infection, inflammation
Colonoscopy: Examination of the inside of the colon and large intestine to detect polyps, tumors,
ulceration, inflammation, colitis diverticula, Chrohn's disease, and discovery and removal of
foreign bodies.
Colposcopy: Direct visualization of the vagina and cervix to detect cancer, inflammation, and
other conditions.
Cystoscopy: Examination of the bladder, urethra, urinary tract, uteral orifices, and prostate (men)
with insertion of the endoscope through the urethra
EGD (Esophogealgastroduodensoscopy): visual examination of the upper gastro-intestinal (GI)

tract. (also referred to as gastroscopy) to reveal hemorrhage, hiatal hernia, inflammation of the
esophagus, gastric ulcers.
Laparoscopy: visualization of the stomach, liver and other abdominal organs including the
female reproductive organs, for example, the fallopian tubes.
Laryngoscopy: examination of the larynx (voice box).

Diagnostic: Goal is to learn something about the tissue
Therapeutic: Goal is to modify the tissue, e.g. kill malignant cells.
Diathermy - is the treatment process by which cutting, coagulation of tissues are obtained.
Induction Electrodes- Creates a stronger magnetic field than electrical field. A cable or coil is
wrapped circumferentially around an extremity or coiled within an electrode
SCE 140 DEPT.OF ECE

UNIT I
ELECTRO PHYSIOLOGY AND BIO POTENTIAL RECORDING
PART-A
1. What is meant by cell?

The basic living unit of the body is cell. The function of organs and other Structure
of the body is understood by cell organization.
2. Give the abbreviation form for RNA, DNA?
RNA –Ribo Nucleic Acid DNA—De- Oxy Nucleic Acid
3. What are resting and action potential, bio electric potential?

The membrane potential caused by the different concentration of ions is calledresting
potential. It is caused by very rapid change of membrane Permeability to sodium ions
followed by recovery period.The positive potential of the cell membrane during excitation is
called action potential. Certain systems of the body generate their own monitoring
signals conveying useful information about the functions they represent. Such signals
are bio electric potentials and are related to nerve conduction, brain activity, heart beat etc.
4.What is meant by measurement.
Measurement is an act or the result of comparison between the quantity and a predefined
standard.
5. Mention the basic requirements of measurement.

The standard used for comparison purpose must be accurately defined and should
be commonly accepted. The apparatus used and the method adopted must be provable.
6. What are the 2 methods for measurement?

1.Directmethod
2. Indirect method.
7. Explain the function of measurement system.

The measurement system consists of a transuding element which converts the quantity to be
measured in an analogous form the analogous signal is then processed by some intermediate means
and is then fed to the end device which presents the results of the measurement.
8. Define Instrument.
Instrument is defined as a device for determining the value or magnitude of a quantity or variable.
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9. List the types of instruments?
The 3 types of instruments are
1) Mechanical Instruments
2) Electrical Instruments and
3) Electronic Instruments.
10. Classify instruments.
1)AbsoluteInstruments
2)Secondary Instruments
11.What is meant by Resting Potential?
Equilibrium is reached with a potential difference across the membrane such that negative on
inside and positive on outside. This membrane potential caused by the different concentration
of irons is called Resting Potential.
12.What is meant by Action Potential?
Cell has a slightly positive potential on the inside due to imbalance of potassium ions. This
positive potential of the cell membrane during excitation is called Action Potential and is about 20 mV.
13.Give any 4 factors to be considered when we design any medical Instrument?
Accuracy,
Frequency Response,
Linearity, S/N ratio,
Stability,
sensitivity
14.What is Electrode Potential?
The voltage developed at an electrode-electrolyte interface is known as Electrode Potential.
15.What is the purpose of electrode paste?
The electrode paste decreases the impedance of the contact the artifacts resulting from the
movement of the electrode or patient.
16.Give the different types of electrodes?
Microelectrodes,
Depth and needle electrodes,
Surface electrodes
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17.Give the different types of Surface electrodes?
1) Metal Plate electrodes 2) Suction cup electrodes

3) Adhesive tape electrodes 4) Multi point electrodes
5) Floating electrodes.
18. What is PH electrode?
The chemical balance of human body is identified by measurement of Ph content of blood

and other body fluids. PH is defined as logarithm of reciprocal of hydrogen ion concentration.
19. Define polarized and non polarized electrode.
Electrodes in which no net transfer of charge occurs across the metal electrolyte interface is called
as perfectly polarized electrodes.Electrodes in which un hindered exchange of charge occurs across
the metal electrode interface is called perfectly non polaraisable electrodes.
20. What is plethysmograph?
The instrument used for measuring blood volume is called plethysmograph.
UNIT II
1.Mention various types of chemical electrodes.
Hydrogen electrode,
ph electrode,
po2 electrode,
pco2 electrode.
2..Define circulation and respiration?
We can define from the engineering point of view, the circulation is a high resistance circuit
with a large pressure gradient between the arteries and veins The exchange of any gases
in any biological process is termed as respiration
3.What is mean by transducer?
It is a device which detects or senses the bio signal and converts it in to an electrical signal for
bio signal processing
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4 .What is electrophoresis?
Electrophoresis is a technique used to separate biological molecules, such as nucleic acids,

carbohydrates, and amino acids, based on their movement due to the influence of a direct electric
current in a buffered solution. Positively charged molecules move toward the negative electrode,
while negatively charged molecules move toward the positive electrode.
5.What are the different methods to measure the blood pressure?
1.Indirect method using sphygmomanometer.

2.Direct method.
6.What is the use of blood flowmeter in bio medical instrumentation?
Blood flow meters are used to monitor the blood flow in various blood vessels and it also helps
to measure cardiac output.
7. What are the different types of blood flow meters?
Electromagnetic blood flow meter,

Ultrasonic blood flow meter,
Laser Doppler
Blood flow meter,
NMR Blood flow meter.
8.Give some applications of electromagnetic blood flow meters.
Blood flow measurements during cardiac surgery, blood flow measurements during shunt operations,
blood flow measurements during carotid artery, blood flow measurements in rural arteries, blood flow
measurements during organ transplantation.
9. What is cardiac output?
Cardiac output is the quantity of blood delivered by the heart to the aorta per minutes. It is a
major determinant of oxygen delivery to the tissues.
10.What happens when there is a fall in cardiac output?
A fall in cardiac output may result in low blood pressure, reduces tissues oxygenation, acidosis,
poor renal function and shock.
11.What are the different types of dilution methods?
Indicator dilution method, Dye dilution method, Thermal dilution method.
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12.How Cardiac output is measured in thermal dilution method?
A thermal indicator of known volume introduced into either the right or left atrium will produce a
resultant temperature change in the pulmonary artery or in the aorta respectively, the integral of which
is inversely proportional to the cardiac output.
Cardiac output=a constant X(blood temp-inject ate temp)/area under dilution curve.
13.What is the use of blood flow meter in bio medical instrumentation?
Blood flow meters are used to monitor the blood flow in various blood vessels and it also helps to
measure cardiac output.
14.What are the two different principles used in ultrasonic blood flow measurement?
Transit Time method: In this method, a peizo electric crystal emits a brief pulse of ultrasound
which propagates diagonally across the blood vessel.
Doppler effect based method: In this method , as per Doppler effect, there is a change in frequency
of reflected ultrasonic wave, due to motion of blood , when it crosses blood.
15. Define transit time principle of ultrasonic blood flow meter.
In Transit time method a piezo electric crystal emits a brief pulse of ultrasound which propagates
diagonally across the blood vessel.
The pulse reaches a receiving crystal situated on the opposite side wall of the blood vessel.
Electronic circuitry attached externally interprets transit time to velocity.
16. What is Sphygmomanometer?
Sphygmomanometer is a dvice used by the physician to measure blood pressure.
It is used for indirect BP measurement and it consists of inflatable rubber bladder called
the cuff, a rubber squeeze ball pump and value assembly and a manometer.
17.What is BSR?
BSR means based skin response, which gives the baseline value of skin resistance.
18.What is GSR?
GSR means galvanic skin response, which gives the measure of average activity of the sweat
glands and is a measure of phasic activity of sweat glands.
19. What is plethysmograph?
Plethysmograph is used to measure the constant volume changes or constant pressure changes in
the chamber.
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20.What is korotkoff sound?
In the BP measurement, When the systolic pressure exceeds the cuff pressure, then the doctor can
hear some crashing , snapping sound through the stethoscope. This is known as korotkoff sound.
UNIT III
1. Define circulatory system
It is a type of transport system. It helps in supplying the oxygen and digested food to different
parts of our body and removing CO2 from the blood. The heart is the center of the circulatory
system.
2.Define heart, lung?
Heart is a pumping organ which eats regularly and continuously for years. It beats
seventy times a minute at rest. Contraction is systole and relaxation is diastole.
3.Define circulation?
We can define from the engineering point of view, the circulation is a high resistance
circuit with a large pressure
4. Classify the pacemakers
Fixed rate pacemakers.

Ventricular Synchronous pacemakers
Demand pacemakers
Atrial Synchronous pacemakers
5. Different methods of stimulation
External stimulation,
Internal stimulation
6.What is a Defibrillator?
A defibrillator is an electronic device that creates a sustained myocardial depolarization of a

patient s heart in order to stop ventricular fibrillation or artial fibrillation.
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7.What are the characteristics of a DC amplifier?
It may need balanced differential inputs giving a high common mode ratio (CMRR). It
should have an extremely good thermal and long term stability.
8. Enumerate the merits and demerits of a dc amplifier?
It is easy to calibrate at low frequencies.It is able to recover from an overload condition

unlike it’s AC counterpart.
9.Give the purpose of bridge circuits. What are the different types?
The bridge circuits are used in instrumentation systems for the measurement of resistance ,
inductance and capacitance.
Types:
DC type and
AC type.
10.What are the 2 types of wheatstone bridge?
Null type bridge

Deflection type bridge.
11.What are the different types of AC bridges?
AC bridge using push-pull transducers

AC bridge with push-pull inductive transducers
Inductive transducer
Blumlein Bridge Capacitive transducer
12.Define slew rate
Slew rate is defined as the maximum output voltage change per unit time.
13.List the requirements of an instrumentation amplifier
Low drift
High i/p impedance
High linearity
High CMRR
High noise rejection capability
14.Give few applications of instrumentation amplifier.
The instrumentation amplifier finds increasing application in the amplification of the output
signalsobtained from thermocouples, strain gauge bridge and biological electrode.
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15.What is a filter?
A filter is often a frequency selective circuit that passes a specified band of frequencies and blocks
or attenuated signal of frequencies outside this band.
16. Specify the advantages of an active filter
Gain and frequency adjustment flexibility

No loading problem
Low cost
17.What is frequency scaling?
The procedure of converting a cutoff frequency to a new cutoff frequency is called frequency
scaling.
18.What is quality factor?
The ratio of resonant frequency to bandwidth is known as the quality factor Q.
19.What is acquisition time of S/H circuit?
Acquisition time is the time required for the capacitor to charge up to the value of the input voltage
after the switch is first started.
20.What is aperture time of S/H circuit?
The aperture time is the time required for the switch to change from ON state to OFF state.
UNIT IV
1. List the important features of CRT.
Size
Operating voltages
Deflection voltages
Viewing screen .
2. What is meant by deflection sensitivity in CRT?
The deflection sensitivity of the CRT is usually stated as the DC voltage required for each cm of
deflection of the spot on the screen.
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3. What is meant by recurrent sweep in CRT?
When the saw tooth, being an AC voltage alternates rapidly, the display occurs respectively, so that
a lasting image is seen by the eye. This repeated operation is known as recurrent sweep.
4. Mention the methods that are used for generating the 2 electron
beams within the CRT.
The methods that are used for generating the 2 electron beams within the CRT are the
double gun tube and split beam method.
5. Explain CRO and its function.
Cathode Ray Oscilloscope (CRO) is a very careful and versatile laboratory instrument used for
display measurement and analysis of waveforms and other phenomena in electrical and electronic
circuits. is in fact a very fast X-Yplotter displaying an input signal versus another signal or time.
6.Name the components of a CRO.
CRO consists of a cathode ray tube (CRT) along with electron gun assembly, deflection plate
assembly, fluorescent screen, glass envelope and base.
7.What is an electron gun?
The source of focused and accelerated electron beam is the electron gun.The electron gun
which emits electrons and forms them into a beam consists of a heater, a cathode, a grid a pre-
accelerating anode, a focusing anode and an accelerating anode.
8.Name the basic circuitry of CRO.
Vertical (Y) deflection system

Horizontal (X) deflection system
Synchronization
Blanking circuit
Intensity (z-axis) modulation
Positioning controls
Focus control
Intensity control
9.Write notes on LVDT
It is the linear variable differential transformer which is used to translate the linear
motion into electrical signals. It consists of a single primary winding and 2 secondary winding.
SCE 149 DEPT.OF ECE

10.What is a digitizer?
It is a digital encoding transducer that enables a linear or rotary displacement to

be directly converted into digital form without intermediate forms of analog to digital (A/D)
conversion.Heart is a pumping organ which eats regularly and continuously for years. Itbeats
seventy times a minute at rest. Contraction is systole and relaxation is diastole.
11.Define circulation and respiration?
We can define from the engineering point of view, the circulation is a high resistance circuit
with a large pressure gradient between the arteries and veins.The exchange of any gases in any
biological process is termed as respiration
12.What is mean by transducer?
It is a device which detects or senses the bio signal and converts it in to an electrical signal for
bio signal processing
13.Define strain gauge?
It is a electrical device which is used to measure stress or pressure in terms of strain using
the principle of change of resistively due to mechanical stress
14.How are transducer are classified?
They can be classified into different types based on the energy conversion, application and so
on. They are two types
Active transducer:
Passive transducer
15.What are applications of X-ray?

1.To visible skeletal structures
2.TO take chest radiograph
3.o identify lung tumors
4.Gastroimtestinal tract and urinary tract can be examined.
16.Define macro shock.

A physiological response to a current applied to the surface of the body that produces
unwanted stimulation like tissue injury or muscle contraction is called macro shock.
17.Define micro shock

A physiological response to a current applied to the surface of the heart that results in
unnecessary stimulation like muscle contraction or tissue injury
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18.What are the devices used to protect against electrical hazards ?

1.Ground fault interrupter
2.Isolation transformer
19. What are advantages of laser surgery?

High sterile
Highly localized and precise
Non contact and bloodless surgery
Short period of surgical time and painless surgery
20.Name the types of lasers used in medicine

Pulsed Nd-YaG laser
Continuous wave CO2 laser
Continuous wave organ ion laser
21 .List the advantages of LVDT
High range of displacement measurement

Friction & electrical isolation
Immunity from external effects
High I/p and high sensitivity
Ruggedness
Low hysterisis & low power consumption.
UNIT V
RECENT TRENDS IN MEDICAL INSTRUMENTATION
1.What is LED?
The LED is basically a semiconductor PN junction diode capable of emitting

electromagnetic radiation under forward conductions.
2.Compare common anode and common cathode displays.
Common anode type display require an active low (or current linking) configuration
for code converter circuitry, whereas an active high output circuit is necessary for common
cathode LED type display.
3.List the characteristics of LCD.
Light scattering Can operate in reflective or Transmissive configuration.

Do not actively generate light and depend for their operation on ambient or back light.
SCE 151 DEPT.OF ECE
4 .On what does the operation of LCD depend?
The utilization of a class of organic materials which remain a regular crystal like
structure even when they have melted.
5.Name the 2 commonly available types of LCDs.
Dynamic scattering and

Field effect type.
6.What is the purpose of dot matrix displays?
Excellent alphanumeric characters can be displayed by using dot matrix LEDs with an
LED at each dot location.
7.What are the commonly used dot matrices for the display of characters?
The commonly used dot matrices for the display of prominent characters are 5 x 7, 5 x 8
and 7 x 9.
8.What are the 2 writing patterns of dot matrix displays?
Common anode or common cathode connection (uneconomical)

X-Y array connection (economical and can be extended vertically or horizontally
using a minimum number of wires)
9. Define transducers.
Transducers are defined as a device which when actuated, transforms energy from
one form to another. Generally, any physical parameters is converted into electrical form.
10.What are the 2 types of transducers?
Electrical and
Mechanical
11.Name the parameters that dictate the transducer capability

Linearity
Resolution
Reliability
12.Define sensitivity
Sensitivity is defines as the electrical output per unit change in the physical parameter.
High sensitivity is generally desirable for a transducer.
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13.Classify electrical transducers.
Active
Passive
14.Name the 2 parts of a transducer
Sensing element
Transduction element
15.Mention the factors considered while selecting a transducer.
Operating range
Sensitivity
Frequency response & resonant frequency
Environmental compatibility
Minimum
sensitivity
Accuracy
Usage and ruggedness
Electrical parameters
16.What is meant by POT?
POT is a resistive potentiometer used for the purpose of voltage division. It consists for
a resistive element provided with a sliding contact called as wiper.
17. Explain the working principle of a strain gauge.
Strain gauge works on the principal that the resistance of a conductor or a

semiconductor changes when strained. This property can be used for
measurement of displacement, force and pressure.
18. What is meant by rosette?
It is a combination of strain gauges to a single element strain gauge.
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A Course Material on

DEPARTMENT OF ELECTRONICS AND COMMUNICATION

SASURIE COLLEGE OF ENGINEERING

VIJAYAMANGALAM – 638 056

This is to certify that the e-course material

Subject Code : EC2021

Scubject : Medical Electronics

Class : III Year ECE

being prepared by me and it meets the knowledge requirement of the university

Signature of the Author

ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING

BIO-CHEMICAL AND NON ELECTRICAL PARAMETER MEASUREMENT

ASSIST DEVICES AND BIO-TELEMETRY

RECENT TRENDS IN MEDICAL INSTRUMENTATION

UNIT I ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL

UNIT II BIO-CHEMICAL AND NON ELECTRICAL PARAMETER

UNIT III ASSIST DEVICES AND BIO-TELEMETRY 9

UNIT IV RADIOLOGICAL EQUIPMENTS 9

UNIT V RECENT TRENDS IN MEDICAL INSTRUMENTATION 9

REFERENCES TOTAL PERIOS:45

ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING

1.1 THE ORIGIN OF BIO-POTENTIALS:

 Bioelectric phenomenon is of immense importance to biomedical engineers because

To understand the origin of biopotentials we need to focus on:

 Bioelectric phenomena at the cellular level

1.1.1 ELECTRICAL ACTIVITY OF EXCITABLE CELLS

 Biopotentials are produced as a result of electrochemical activity of excitable cells: i.e.,

Factors influencing the flow of ions across the cell membrane

SCE 1 DEPT.OF ECE

1.1.2 BIOELECTRIC PHENOMENA AT THE CELLULAR LEVEL

Figure 1.1 Recording of action potential

A very important topic in electrophysiology is the relationship between intracellular and

Figure 1.2 Waveforms of intracellular action potential

SCE 2 DEPT.OF ECE

Figure 1.3 Waveforms of Extracellular action potential

Figure 1.4 Volume conductor fields of simple bioelectric sources

SCE 3 DEPT.OF ECE

1.2 BIOPOTENTIAL ELECTRODES

Electrode – Electrolyte Interface

General Ionic Equations

The dominating reaction can be inferred from the following :

 Current flow from electrode to electrolyte : Oxidation (Loss of e-)

Figure 1.5 Electrolyte Interface

Half Cell Potential

 A characteristic potential difference established by the electrode and its surrounding

SCE 4 DEPT.OF ECE

Half cell potential cannot be measured without a second electrode.

Reason for Half Cell Potential : Charge Separation at Interface

 Oxidation or reduction reactions at the electrode-electrolyte interface lead to a double-

Measuring Half Cell Potential

Figure 1.6 Half Cell Potential

Polarizable and Non-Polarizable Electrodes

SCE 5 DEPT.OF ECE

Figure 1.7 Equivalent Circuit

Electrode Skin Interface

Body Surface Recording Electrodes

Figure 1.8 Body surface Recording Electrodes

SCE 6 DEPT.OF ECE

Metal plate electrodes

Figure 1.9 Metal plate Electrode

Figure 1.10 Suction Electrode

SCE 7 DEPT.OF ECE

Adhesive-tape Electrolyte gel